Organization
MERCY CLINIC JOPLIN, LLC
Active
Other names
Mercy Clinic-Oswego-Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY A GODFREY MD (PRESIDENT)
(417) 556-8962
Entity
Organization
Contact information
Practice address
805 BARKER DR, OSWEGO, KS 67356
(620) 795-2525
Mailing address
645 MARYVILLE CENTRE DR FL 3, SAINT LOUIS, MO 63141-5855
(417) 820-7133
(417) 820-0586
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740517341
KANSAS BLUE CROSS
KS
05
—
1740517341
—
MO
05
—
200274980E
—
OK
05
—
200639810F
—
KS
01
—
615149202
DEPARTMENT OF LABOR (OWCP-DEEOIC)
KS
Enumeration date
11/03/2009
Last updated
06/11/2018
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