Provider Demographics
NPI:1285930206
Name:MERCY CLINIC CHILD NEUROLOGY, LLC
Entity type:Organization
Organization Name:MERCY CLINIC CHILD NEUROLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-364-3707
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 5009-B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-5866
Mailing Address - Fax:314-251-5867
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 5009-B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-5866
Practice Address - Fax:314-251-5867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CLINIC EAST COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty