Provider Demographics
NPI:1417381831
Name:MERCY HOSPITAL SPRINGFIELD
Entity Type:Organization
Organization Name:MERCY HOSPITAL SPRINGFIELD
Other - Org Name:MERCY PHARMACY EVANS ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR-RETAIL PHARMACY SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-5606
Mailing Address - Street 1:3050 E RIVER BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8807
Mailing Address - Country:US
Mailing Address - Phone:417-885-3357
Mailing Address - Fax:417-885-3363
Practice Address - Street 1:3050 E RIVER BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8807
Practice Address - Country:US
Practice Address - Phone:417-885-3357
Practice Address - Fax:417-885-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20130300873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141064OtherPK