Provider Demographics
NPI:1346325032
Name:MERCY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MERCY HEALTH SERVICES LLC
Other - Org Name:MERCY HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RPH
Authorized Official - Phone:314-506-6149
Mailing Address - Street 1:13185 LAKEFRONT DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1510
Mailing Address - Country:US
Mailing Address - Phone:314-506-6050
Mailing Address - Fax:314-506-6284
Practice Address - Street 1:13185 LAKEFRONT DR
Practice Address - Street 2:SUITE 120
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1510
Practice Address - Country:US
Practice Address - Phone:314-506-6050
Practice Address - Fax:314-506-6284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X
MO006006251F00000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO608291704Medicaid
MO1057840001Medicare UPIN
MO1057840001Medicare ID - Type Unspecified