Organization
SOUTHEAST HOSPITAL
Active
Other names
MERCY PHARMACY BROADWAY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA BERRY (CFO)
(573) 331-6028
Entity
Organization
Contact information
Practice address
1723 BROADWAY STE 110, CAPE GIRARDEAU, MO 63701
(573) 331-7900
(573) 331-7909
Mailing address
1723 BROADWAY STE 110, CAPE GIRARDEAU, MO 63701
(573) 331-7900
(573) 331-7909
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
006426
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2631996
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
603829300
—
MO
Enumeration date
08/10/2006
Last updated
01/13/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up