Basic Information
Provider Information
NPI: 1578969366
EntityType: 2
ReplacementNPI:  
OrganizationName: MERCY HOSPITAL LINCOLN
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 106 BROADWAY ST
Address2: ,SUITE 3C
City: ELSBERRY
State: MO
PostalCode: 633431345
CountryCode: US
TelephoneNumber: 5738989100
FaxNumber:  
Practice Location
Address1: 106 BROADWAY ST
Address2: ,SUITE 3C
City: ELSBERRY
State: MO
PostalCode: 633431345
CountryCode: US
TelephoneNumber: 5738989100
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/06/2014
LastUpdateDate: 11/06/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: JOHNSTON
AuthorizedOfficialFirstName: JEFFREY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT-MERCY HOSP STL
AuthorizedOfficialTelephone: 3142516000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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