Provider Demographics
NPI:1952679334
Name:MERCY HOSPITAL CARTHAGE
Entity Type:Organization
Organization Name:MERCY HOSPITAL CARTHAGE
Other - Org Name:MERCY MCCUNE-BROOKS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-556-2459
Mailing Address - Street 1:3125 DR RUSSELL SMITH WAY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7402
Mailing Address - Country:US
Mailing Address - Phone:417-358-8121
Mailing Address - Fax:
Practice Address - Street 1:3125 DR RUSSELL SMITH WAY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7402
Practice Address - Country:US
Practice Address - Phone:417-358-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
26U228Medicare UPIN
26Z326Medicare Oscar/Certification