Provider Demographics
NPI:1588939797
Name:MERCY EAST COMMUNITY
Entity type:Organization
Organization Name:MERCY EAST COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:314-966-8500
Mailing Address - Street 1:12360 MANCHESTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4312
Mailing Address - Country:US
Mailing Address - Phone:314-966-8500
Mailing Address - Fax:
Practice Address - Street 1:12360 MANCHESTER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4312
Practice Address - Country:US
Practice Address - Phone:314-966-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006258261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care