1477765204 NPI number — MERCY HOSPITAL SPRINGFIELD

Table of content: (NPI 1477765204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477765204 NPI number — MERCY HOSPITAL SPRINGFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL SPRINGFIELD
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:
1477765204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 E CHEROKEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65804-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-820-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 NORTH HIGHWAY 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020-3561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-1026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT - FINANCE
Authorized Official Telephone Number:
417-820-2818

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  029068 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 806331005 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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