Healthcare Provider Details

I. General information

NPI: 1922108679
Provider Name (Legal Business Name): MERCY MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 NW STEWART PKWY
ROSEBURG OR
97471-1596
US

IV. Provider business mailing address

2700 NW STEWART PKWY
ROSEBURG OR
97471-1281
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4836
  • Fax: 541-677-6568
Mailing address:
  • Phone: 541-677-4836
  • Fax: 541-677-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOHN S. KASBERGER
Title or Position: VICE PRESIDENT CFO
Credential:
Phone: 541-677-2458