Provider Demographics
NPI:1720417066
Name:MERCY HOSPITAL BOONEVILLE
Entity Type:Organization
Organization Name:MERCY HOSPITAL BOONEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLOUSE DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-8439
Mailing Address - Street 1:880 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-3443
Mailing Address - Country:US
Mailing Address - Phone:479-969-8640
Mailing Address - Fax:
Practice Address - Street 1:351 E PRIDDY ST
Practice Address - Street 2:
Practice Address - City:MAGAZINE
Practice Address - State:AR
Practice Address - Zip Code:72943-8503
Practice Address - Country:US
Practice Address - Phone:479-969-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205182729Medicaid