MEDICARE: MERCY HOSPITAL JEFFERSON

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
1	251E00000X	Home Health Agency	198-20	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G2149017	OTHER	MO	HEALTHLINK
2	83	OTHER	MO	BLUECROSS/BLUESHIELD OF M
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6000091	OTHER	MO	UNITED HEALTHCARE
5	99513	OTHER	MO	GROUP HEALTH PLAN

General Provider Information

NPI Number	:	1396748588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOSPITAL JEFFERSON

Provider Business Mailing Address
First Line	:	151 INDUSTRIAL DR
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4134
Country	:	US
Telephone Number	:	636-933-1162
Fax Number	:	636-933-1579

Provider Business Practice Location Address
First Line	:	151 INDUSTRIAL DR
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4134
Country	:	US
Telephone Number	:	636-933-1162
Fax Number	:	636-933-1579

Authorized Official
Title or Position	:	VICE PRESIDENT FINANCE
Name	:	DANIEL ECKENFELS
Credential	:
Telephone Number	:	314-525-1483

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/28/2021

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Directions to “MERCY HOSPITAL JEFFERSON ” Practice Location

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