Provider Demographics
NPI:1942847413
Name:SOUTHEAST HOSPITAL
Entity Type:Organization
Organization Name:SOUTHEAST HOSPITAL
Other - Org Name:MERCY PHARMACY JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-331-6028
Mailing Address - Street 1:2600 E. MAIN STREET
Mailing Address - Street 2:SUITE 113
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-755-2315
Mailing Address - Fax:573-519-4676
Practice Address - Street 1:2600 E. MAIN STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755
Practice Address - Country:US
Practice Address - Phone:573-755-2315
Practice Address - Fax:573-519-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy