1447265848 NPI number — MERCY HEALTH SERVICES CORPORATION

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 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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