Healthcare Provider Details

I. General information

NPI: 1558573386
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 E HIGHWAY 32
STOCKTON MO
65785-8351
US

IV. Provider business mailing address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-276-5444
  • Fax:
Mailing address:
  • Phone: 417-820-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number039004
License Number StateMO

VIII. Authorized Official

Name: MR. SCOTT R REYNOLDS
Title or Position: VICE PRESIDENT - FINANCE
Credential:
Phone: 417-820-2818