Organization
MERCY CLINIC JOPLIN LLC
Active
Other names
Mercy Clinic Columbus-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
101 W SYCAMORE ST, COLUMBUS, KS 66725
(620) 429-3636
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
—
1750618351
KANSAS BLUE CROSS
KS
05
—
1750618351
—
MO
05
—
200639810E
—
KS
01
—
615149203
DEPARTMENT OF LABOR (OWCP-FECA)
KS
Enumeration date
11/03/2009
Last updated
06/11/2018
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