Provider Demographics
NPI:1508859661
Name:MERCY HOSPITAL JEFFERSON
Entity Type:Organization
Organization Name:MERCY HOSPITAL JEFFERSON
Other - Org Name:JEFFERSON MEMORIAL HOSPITAL ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-1107
Mailing Address - Street 1:1400 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-933-1000
Mailing Address - Fax:636-933-1819
Practice Address - Street 1:1400 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-933-1000
Practice Address - Fax:636-933-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO160-47282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010155703Medicaid
MO000050054Medicare Oscar/Certification
MO823150091Medicare PIN
MO030050054Medicare PIN
MO010155703Medicaid
MO836490091Medicare PIN
MO825400054Medicare PIN
MO004050054Medicare PIN
MO002050054Medicare PIN
MO091050054Medicare PIN
MO000060091Medicare Oscar/Certification
MO990015497Medicare PIN
MOCF9172Medicare Oscar/Certification
MO817750091Medicare PIN
MO908010054Medicare PIN
MO003050054Medicare PIN
MO001050054Medicare PIN