# MERCY CLINIC JOPLIN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417216938
- **Authorized official:** TRACY A GODFREY MD (PRESIDENT)
- **Authorized official phone:** (417) 556-8962

## Contact information

- **Practice address:** 310 2ND AVE SW, MIAMI, OK 74354-6743
- **Practice address phone:** (417) 556-8600
- **Practice address fax:** (417) 556-8602
- **Mailing address:** 100 MERCY WAY, JOPLIN, MO 64804-4524
- **Mailing address phone:** (417) 556-8994
- **Mailing address fax:** (417) 556-8962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/04/2012
- **Last updated:** 07/02/2015