Provider Demographics
NPI:1447265848
Name:MERCY HEALTH SERVICES CORPORATION
Entity type:Organization
Organization Name:MERCY HEALTH SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-781-2727
Mailing Address - Street 1:PO BOX 121037
Mailing Address - Street 2:DEPT 1037
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-1037
Mailing Address - Country:US
Mailing Address - Phone:417-627-8424
Mailing Address - Fax:417-627-8425
Practice Address - Street 1:3120 S MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2643
Practice Address - Country:US
Practice Address - Phone:417-627-8424
Practice Address - Fax:417-627-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100139610DMedicaid
MO104160OtherBLUE CROSS PROV NUMBER
MO628124703Medicaid
KS400802OtherBLUE CROSS PROVIDER NUMBE
OKS=========6Medicaid
0760940003Medicare NSC