Healthcare Provider Details

I. General information

NPI: 1912020397
Provider Name (Legal Business Name): ST. JOHN'S MERCY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

IV. Provider business mailing address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8000
  • Fax: 636-239-8890
Mailing address:
  • Phone: 636-239-8000
  • Fax: 636-239-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL M. MCCURRY
Title or Position: PRESIDENT
Credential:
Phone: 314-628-3423