Provider Demographics
NPI:1154455095
Name:ST. JOHN'S MERCY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. JOHN'S MERCY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:314-252-8885
Mailing Address - Street 1:12680 OLIVE BOULEVARD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:413-251-8885
Mailing Address - Fax:314-251-8881
Practice Address - Street 1:12680 OLIVE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6322
Practice Address - Country:US
Practice Address - Phone:413-251-8885
Practice Address - Fax:314-251-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019223282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital