Provider Demographics
NPI:1558709071
Name:MERCY HOSPITAL LEBANON
Entity Type:Organization
Organization Name:MERCY HOSPITAL LEBANON
Other - Org Name:MERCY CLINIC AGAPE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-2818
Mailing Address - Street 1:331 HOSPITAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-9217
Mailing Address - Country:US
Mailing Address - Phone:417-820-6780
Mailing Address - Fax:
Practice Address - Street 1:331 HOSPITAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9217
Practice Address - Country:US
Practice Address - Phone:417-820-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health