Basic Information
Provider Information
NPI: 1568481984
EntityType: 2
ReplacementNPI:  
OrganizationName: MERCY HOSPITAL SOUTH
LastName:  
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Mailing Information
Address1: 10010 KENNERLY RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631282106
CountryCode: US
TelephoneNumber: 3145251000
FaxNumber:  
Practice Location
Address1: 10010 KENNERLY RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631282106
CountryCode: US
TelephoneNumber: 3145251000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/18/2006
LastUpdateDate: 05/04/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ECKENFELS
AuthorizedOfficialFirstName: DANIEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF FINANCE
AuthorizedOfficialTelephone: 3145251483
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
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NPICertificationDate: 05/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X106904MON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 
282N00000X273-34MOY HospitalsGeneral Acute Care Hospital 

ID Information
IDTypeStateIssuerDescription
14801 BLUE CROSSOTHER
54395560305MO MEDICAID
01016100805MO MEDICAID


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