MEDICARE: MERCY HOSPITAL SPRINGFIELD

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	183500000X	Pharmacist	2011020757	MO
2	333600000X	Pharmacy	2011020757	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2627074	OTHER	MO	NCPDP #

General Provider Information

NPI Number	:	1770528382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOSPITAL SPRINGFIELD

Provider Business Mailing Address
First Line	:	105 W ELDON ST
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1903
Country	:	US
Telephone Number	:	573-265-8901
Fax Number	:	573-265-8310

Provider Business Practice Location Address
First Line	:	105 W ELDON ST
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1903
Country	:	US
Telephone Number	:	573-265-8901
Fax Number	:	573-265-8310

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. PATRICK BERRY
Credential	:
Telephone Number	:	314-628-5606

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	11/01/2017

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Directions to “MERCY HOSPITAL SPRINGFIELD ” Practice Location

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