=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790720282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY HOSPITALS EAST COMMUNITIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15945 CLAYTON RD SUITE 230
-----------------------------------------------------
City | CLARKSON VALLEY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-256-5200
-----------------------------------------------------
Fax | 636-256-5223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15945 CLAYTON RD SUITE 230
-----------------------------------------------------
City | CLARKSON VALLEY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-256-5200
-----------------------------------------------------
Fax | 636-256-5223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DENISE SCOFFIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-251-1917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------