Healthcare Provider Details

I. General information

NPI: 1598712366
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2752
  • Fax: 417-820-8299
Mailing address:
  • Phone: 417-820-2752
  • Fax: 417-820-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number000953
License Number StateMO

VIII. Authorized Official

Name: MR. PATRICK BERRY
Title or Position: EXEC DIR-RETAIL PHARMACY SVCS
Credential:
Phone: 314-628-5606