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General NPI Number Information
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NPI Number | 1518997469
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Entity Type | Organization
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Legal Business Name | MERCY REGIONAL HEALTH SYSTEMS
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 205 BAILEY LN
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City | BENTON
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State | IL
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Zip | 62812-1921
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Country | US
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Telephone | 618-439-9400
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Fax | 618-439-7138
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Provider Business Mailing Address
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Address Line | 205 BAILEY LN P O BOX 337
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City | BENTON
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State | IL
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Zip | 62812-1921
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Country | US
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Telephone | 618-439-9400
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Fax | 618-439-7138
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. CLAYTON WHEELER HOBBS
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Credential | PARAMEDIC
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Telephone | 618-439-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 6567
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 344600000X
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Taxonomy Name | Taxi
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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 | 347B00000X
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Taxonomy Name | Bus
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License Number |
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 6567
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License Number State | IL
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