Provider Demographics
NPI:1518997469
Name:MERCY REGIONAL HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MERCY REGIONAL HEALTH SYSTEMS
Other - Org Name:MERCY REGIONAL EMERGENCY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:WHEELER
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:618-439-9400
Mailing Address - Street 1:205 BAILEY LN
Mailing Address - Street 2:P O BOX 337
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1921
Mailing Address - Country:US
Mailing Address - Phone:618-439-9400
Mailing Address - Fax:618-439-7138
Practice Address - Street 1:205 BAILEY LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1921
Practice Address - Country:US
Practice Address - Phone:618-439-9400
Practice Address - Fax:618-439-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6567341600000X, 3416L0300X
343800000X, 343900000X, 344600000X, 347C00000X
IL347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002529972OtherBCBS
IL=========001Medicaid
IL0002529972OtherBCBS