Provider Demographics
NPI:1477505816
Name:MERCY HOSPITAL SPRINGFIELD
Entity Type:Organization
Organization Name:MERCY HOSPITAL SPRINGFIELD
Other - Org Name:MERCY HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-2818
Mailing Address - Street 1:1570 W BATTLEFIELD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4174
Mailing Address - Country:US
Mailing Address - Phone:417-820-5550
Mailing Address - Fax:417-820-5551
Practice Address - Street 1:2115 S FREMONT AVE
Practice Address - Street 2:SUITE 5200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2239
Practice Address - Country:US
Practice Address - Phone:417-820-7099
Practice Address - Fax:417-820-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X
MO005306333600000X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO628578700Medicaid
MO600135412Medicaid
MO0326010002Medicare NSC