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NPI Code Detail

MEDICARE: MERCY CLINIC JOPLIN LLC

MEDICARE: MERCY CLINIC JOPLIN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician
2208600000XSurgery Physician
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
4207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31043547474OTHERKSKANSAS BLUE CROSS

General Provider Information

NPI Number : 1043547474
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY CLINIC JOPLIN LLC
Provider Business Mailing Address
First Line : PO BOX 504944
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-0001
Country : US
Telephone Number : 314-466-6428
Fax Number :
Provider Business Practice Location Address
First Line : 101 W SYCAMORE ST
Second Line :
City : COLUMBUS
State : KS
Zip : 66725-1276
Country : US
Telephone Number : 620-429-3636
Fax Number :
Authorized Official
Title or Position : CFO
Name : MATHEW JANSSENS
Credential :
Telephone Number : 417-556-2459
Provider Enumeration Date : 11/05/2009
Last Update Date : 04/30/2025

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Directions to “MERCY CLINIC JOPLIN LLC ” Practice Location

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