1134673148 NPI number — MERCY EAST AMBULATORY SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134673148 NPI number — MERCY EAST AMBULATORY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY EAST AMBULATORY SERVICES LLC
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:
MERCY URGENT CARE
Provider Other Organization Name Type Code:
5
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:
1134673148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 775641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-206-2665
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1722 CLARKSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-4976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-206-2665
Provider Business Practice Location Address Fax Number:
636-206-2664
Provider Enumeration Date:
08/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FERGUSON
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MANAGER MERCY REVENUE CYCLE
Authorized Official Telephone Number:
314-543-6946

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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