Provider Demographics
NPI:1457306326
Name:MERCY HOSPITAL BERRYVILLE
Entity Type:Organization
Organization Name:MERCY HOSPITAL BERRYVILLE
Other - Org Name:MERCY HOSPITAL BERRYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLOUSE DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-8439
Mailing Address - Street 1:214 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4303
Mailing Address - Country:US
Mailing Address - Phone:870-423-3355
Mailing Address - Fax:870-423-5268
Practice Address - Street 1:214 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-3355
Practice Address - Fax:870-423-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4317282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010569705Medicaid
AR101363105Medicaid