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General NPI Number Information
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NPI Number | 1053759704
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Entity Type | Organization
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Legal Business Name | MERCY ACO PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 615 S NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8221
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Country | US
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Telephone | 314-251-1376
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Fax |
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Provider Business Mailing Address
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Address Line | 625 S NEW BALLAS RD SUITE 7020
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8253
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Country | US
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Telephone | 314-251-1376
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Fax | 314-251-1394
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Authorized Official
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Title or Position | PRESIDENT MERCY ACO
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Name | MR. SHANNON SOCK
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Credential |
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Telephone | 314-251-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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