Healthcare Provider Details

I. General information

NPI: 1316343494
Provider Name (Legal Business Name): MERCY HOSPITAL LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 09/27/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 E CHERRY ST
TROY MO
63379-1520
US

IV. Provider business mailing address

1165 E CHERRY ST
TROY MO
63379-1520
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-7722
  • Fax:
Mailing address:
  • Phone: 636-528-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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