Provider Demographics
NPI:1700370061
Name:MERCY CLINIC EAST COMMUNITIES
Entity Type:Organization
Organization Name:MERCY CLINIC EAST COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MERCY REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-364-4347
Mailing Address - Street 1:15945 CLAYTON RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2493
Mailing Address - Country:US
Mailing Address - Phone:636-893-1356
Mailing Address - Fax:636-893-1358
Practice Address - Street 1:15945 CLAYTON RD STE 310
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2493
Practice Address - Country:US
Practice Address - Phone:636-893-1356
Practice Address - Fax:636-893-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty