Provider Demographics
NPI: | 1285904342 |
---|---|
Name: | MERCY HOSPITAL CARTHAGE |
Entity type: | Organization |
Organization Name: | MERCY HOSPITAL CARTHAGE |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | VP FINANCE MERCY CAH |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHERRY |
Authorized Official - Middle Name: | LYNN |
Authorized Official - Last Name: | CLOUSE DAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 417-820-8439 |
Mailing Address - Street 1: | 1615 HAZEL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CARTHAGE |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64836-3020 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-237-0983 |
Mailing Address - Fax: | 417-237-0997 |
Practice Address - Street 1: | 1615 HAZEL AVE |
Practice Address - Street 2: | |
Practice Address - City: | CARTHAGE |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64836-3020 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-237-0983 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-06 |
Last Update Date: | 2025-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
26-8689 | Medicare UPIN |