Healthcare Provider Details

I. General information

NPI: 1265942619
Provider Name (Legal Business Name): MERCY HOSPITAL LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
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: 636-528-3365
  • Fax: 636-528-4781
Mailing address:
  • Phone: 636-528-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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