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General NPI Number Information
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NPI Number | 1376612572
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Entity Type | Organization
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Legal Business Name | MERCY CLINIC CHILDREN'S CRITICAL CARE, LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD SUITE 6009-B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-251-6598
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Fax | 314-251-7990
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Provider Business Mailing Address
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Address Line | 621 S NEW BALLAS RD SUITE 6009-B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-251-6598
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Fax | 314-251-7990
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Authorized Official
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Title or Position | PRESIDENT, MERCY HOSPITAL ST. LOUIS
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Name | MR. JEFFREY A. JOHNSTON
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Credential |
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Telephone | 314-251-1932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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