Provider Demographics
NPI:1508192543
Name:MERCY HOSPITAL JOPLIN
Entity Type:Organization
Organization Name:MERCY HOSPITAL JOPLIN
Other - Org Name:MERCY HOSPITAL JOPLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PULSIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-625-2200
Mailing Address - Street 1:2727 MCCLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1626
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-625-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPENDING CHOW273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26T001Medicare Oscar/Certification