Provider Demographics
NPI:1003872482
Name:MERCY HEALTH SERVICES-SOUTHERN REGION, LLC
Entity Type:Organization
Organization Name:MERCY HEALTH SERVICES-SOUTHERN REGION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAFZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-3724
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE #141; ATTN: BECKY
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-936-5811
Mailing Address - Fax:405-936-5810
Practice Address - Street 1:1001 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-223-3737
Practice Address - Fax:580-226-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty