Healthcare Provider Details

I. General information

NPI: 1841605029
Provider Name (Legal Business Name): MERCY CLINIC JOPLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 BEE CAVE PKWY STE 213
BEE CAVE TX
78738-6466
US

IV. Provider business mailing address

11701 BEE CAVE PKWY STE 213
BEE CAVE TX
78738-6466
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9219
  • Fax:
Mailing address:
  • Phone: 417-820-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STUART G STANGELAND
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 417-820-6556