Provider Demographics
NPI:1598057945
Name:MERCY HOSPITAL JOPLIN
Entity Type:Organization
Organization Name:MERCY HOSPITAL JOPLIN
Other - Org Name:MERCY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
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 1:4500 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4404
Mailing Address - Country:US
Mailing Address - Phone:417-781-2004
Mailing Address - Fax:417-623-1420
Practice Address - Street 1:101 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1276
Practice Address - Country:US
Practice Address - Phone:620-429-3960
Practice Address - Fax:620-429-2920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF MERCY HEALTH SYSTEM ST. LOUIS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200654200GMedicaid
KS171577Medicare Oscar/Certification