Healthcare Provider Details

I. General information

NPI: 1083781058
Provider Name (Legal Business Name): MERCY HEALTH NETWORK OF THE SOUTHERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 3RD ST
DAVIS OK
73030-2305
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE #141, ATTENTION BECKY
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 580-369-2803
  • Fax: 580-369-3497
Mailing address:
  • Phone: 405-936-5800
  • Fax: 405-936-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BOBBY G. THOMPSON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 580-220-6611