Basic Information
| Provider Information | |||||||||
| NPI: | 1205162732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HOSPITAL JOPLIN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCY HOSPITAL JOPLIN NEOSHO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 LUSK DR | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648508855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174512060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 LUSK DR | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174512060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2009 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STURGEON | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | TYLER | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4175562459 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | N/A | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.