Healthcare Provider Details

I. General information

NPI: 1407860711
Provider Name (Legal Business Name): MERCY CLINIC ANESTHESIOLOGY - WASHINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/11/2014
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:
Mailing address:
  • Phone: 636-239-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN W. HUBERT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-251-1560