1447265848 NPI number — MERCY HEALTH SERVICES CORPORATION

Table of content: (NPI 1447265848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447265848 NPI number — MERCY HEALTH SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH SERVICES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447265848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 121037
Provider Second Line Business Mailing Address:
DEPT 1037
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75312-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-627-8424
Provider Business Mailing Address Fax Number:
417-627-8425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-2643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-627-8424
Provider Business Practice Location Address Fax Number:
417-627-8425
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARALIS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
417-781-2727

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100139610D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104160 . This is a "BLUE CROSS PROV NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 628124703 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400802 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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