Healthcare Provider Details

I. General information

NPI: 1144399338
Provider Name (Legal Business Name): MERCY CLINIC CHILDREN'S HEART CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS ROAD SUITE 198-A
ST LOUIS MO
63141-8255
US

IV. Provider business mailing address

621 S NEW BALLAS ROAD SUITE 198-A
ST LOUIS MO
63141-8255
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6777
  • Fax: 314-251-5859
Mailing address:
  • Phone: 314-251-6777
  • Fax: 314-251-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY DUNGER
Title or Position: EXECUTIVE DIRECTOR - FINANCE
Credential:
Phone: 314-364-3707