Healthcare Provider Details

I. General information

NPI: 1962808733
Provider Name (Legal Business Name): MERCY HOSPITAL LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E CHERRY ST
TROY MO
63379-1513
US

IV. Provider business mailing address

1000 E CHERRY ST
TROY MO
63379-1513
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-8551
  • Fax:
Mailing address:
  • Phone: 636-528-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK THORN
Title or Position: EXECUTIVE DIRECTOR FINANCE
Credential:
Phone: 636-528-3329