Provider Demographics
NPI:1124355417
Name:MERCY HOSPITAL JEFFERSON
Entity type:Organization
Organization Name:MERCY HOSPITAL JEFFERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ECKENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-1107
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0279
Mailing Address - Country:US
Mailing Address - Phone:636-933-5730
Mailing Address - Fax:636-933-2916
Practice Address - Street 1:1400 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-933-5730
Practice Address - Fax:636-933-2916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH EAST COMMUNITIES - SOUTHERN REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO099121341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2214Medicare PIN