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General NPI Number Information
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NPI Number | 1699809582
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Entity Type | Organization
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Legal Business Name | ST JOHNS MERCY MEDICAL CENTER
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12680 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6322
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Country | US
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Telephone | 314-251-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 12680 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIETITIAN
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Name | MRS. KATHY ELLEN MANKOFSKY
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Credential | RD, LD
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Telephone | 314-251-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 2001010699
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License Number State | MO
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