Provider Demographics
NPI:1467597195
Name:ST JOHNS MERCY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ST JOHNS MERCY HEALTH SERVICES LLC
Other - Org Name:ST. JOHNS MERCY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-364-3380
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-525-4440
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-525-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1057840018Medicare NSC