Provider Demographics
NPI:1184453748
Name:MERCY MEDICAL HEALTH CENTER
Entity type:Organization
Organization Name:MERCY MEDICAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-259-1100
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HODGE
Mailing Address - State:LA
Mailing Address - Zip Code:71247-0070
Mailing Address - Country:US
Mailing Address - Phone:318-259-1100
Mailing Address - Fax:318-259-1333
Practice Address - Street 1:600 FACTORY OUTLET DR STE 12
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3057
Practice Address - Country:US
Practice Address - Phone:318-781-2310
Practice Address - Fax:318-781-2312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)