Provider Demographics
NPI:1346907086
Name:MERCY MEDICAL HEALTH CENTER
Entity Type:Organization
Organization Name:MERCY MEDICAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:318-259-1100
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HODGE
Mailing Address - State:LA
Mailing Address - Zip Code:71247-0070
Mailing Address - Country:US
Mailing Address - Phone:318-259-1100
Mailing Address - Fax:
Practice Address - Street 1:900 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5830
Practice Address - Country:US
Practice Address - Phone:318-251-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental