Provider Demographics
NPI:1235465279
Name:MERCY HOSPITAL JOPLIN
Entity Type:Organization
Organization Name:MERCY HOSPITAL JOPLIN
Other - Org Name:MERCY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PULSIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-625-2200
Mailing Address - Street 1:3120 S MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2608
Mailing Address - Country:US
Mailing Address - Phone:417-627-8424
Mailing Address - Fax:
Practice Address - Street 1:3120 S MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-627-8424
Practice Address - Fax:417-627-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332BX2000X
KS16-00325332BX2000X
OK88-S-2339332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6395360001Medicare NSC