Provider Demographics
NPI:1285640912
Name:MERCY HOSPITAL INC
Entity Type:Organization
Organization Name:MERCY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-345-6391
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:218 E. PACK STREET
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-0180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 E. PACK STREET
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-0180
Practice Address - Country:US
Practice Address - Phone:620-345-6391
Practice Address - Fax:620-345-6344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH059003275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000424OtherBLUE CROSS BLUE SHIELD SW
KS000424OtherBLUE CROSS BLUE SHIELD SW