Organization
MERCY HEALTH SERVICES CORPORATION
Active
Other names
St. John's Medical Equipment Company
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE CARALIS (CHIEF EXECUTIVE OFFICER)
(417) 781-2727
Entity
Organization
Contact information
Practice address
3120 S MAIN ST, SUITE 10, JOPLIN, MO 64804-2643
(417) 627-8424
(417) 627-8425
Mailing address
PO BOX 121037, DEPT 1037, DALLAS, TX 75312-1037
(417) 627-8424
(417) 627-8425
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100139610D
—
KS
01
—
104160
BLUE CROSS PROV NUMBER
MO
01
—
400802
BLUE CROSS PROVIDER NUMBE
KS
05
—
628124703
—
MO
Enumeration date
07/31/2006
Last updated
01/12/2009
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