Provider Demographics
NPI:1578969366
Name:MERCY HOSPITAL LINCOLN
Entity Type:Organization
Organization Name:MERCY HOSPITAL LINCOLN
Other - Org Name:MERCY HOSPITAL LINCOLN FAMILY MEDICINE ELSBERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-528-3329
Mailing Address - Street 1:106 BROADWAY ST
Mailing Address - Street 2:,SUITE 3C
Mailing Address - City:ELSBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:63343-1345
Mailing Address - Country:US
Mailing Address - Phone:573-898-9100
Mailing Address - Fax:
Practice Address - Street 1:106 BROADWAY ST
Practice Address - Street 2:,SUITE 3C
Practice Address - City:ELSBERRY
Practice Address - State:MO
Practice Address - Zip Code:63343-1345
Practice Address - Country:US
Practice Address - Phone:573-898-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
268663Medicare Oscar/Certification