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General NPI Number Information
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NPI Number | 1457344301
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Entity Type | Organization
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Legal Business Name | MERCY PHYSICIAN GROUP
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 403 WOODLAND HILLS BLVD
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City | FORT SCOTT
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State | KS
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Zip | 66701-8798
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Country | US
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Telephone | 620-223-8040
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Fax | 620-223-8524
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Provider Business Mailing Address
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Address Line | 403 WOODLAND HILLS BLVD
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City | FORT SCOTT
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State | KS
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Zip | 66701-8798
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Country | US
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Telephone | 620-223-8040
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Fax | 620-223-8524
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Authorized Official
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Title or Position | FAMILY PHYSICIAN
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Name | MRS. SARA K RAGSDALE
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Credential | D.O
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Telephone | 620-223-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 05-28424
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License Number State | KS
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