1548263585 NPI number — MERCY HOSPITAL JEFFERSON

Table of content: (NPI 1548263585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548263585 NPI number — MERCY HOSPITAL JEFFERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL JEFFERSON
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 HOSPICE
Provider Other Organization Name Type Code:
3
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:
1548263585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 INDUSTRIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-4134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-933-1200
Provider Business Mailing Address Fax Number:
636-933-1579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-1200
Provider Business Practice Location Address Fax Number:
636-933-1579
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ECKENFELS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
314-525-1483

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  025-8HO , 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: 83 . This is a "BLUECROSS/BLUESHIELD OF M" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 820155703 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99513 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 6000091 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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