Basic Information
| Provider Information | |||||||||
| NPI: | 1003201955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HOSPITAL CARTHAGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 DR RUSSELL SMITH WAY | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648367402 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3125 DR RUSSELL SMITH WAY | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173588121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLOUSE DAY | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4178208439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | AO | ||||||||
| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208600000X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0000X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RR0500X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 208VP0000X | 523-4 | MO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 3416L0300X | N | Transportation Services | Ambulance | Land Transport | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 200446020A | 05 | OK | MEDICAID | 01067090 | 05 | MO | MEDICAID | 203923105 | 05 | AR | MEDICAID | 200972980A | 05 | KS | MEDICAID |