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MERCY CLINIC SPECIALISTS SERVICES-ILLINOIS LLC NPI 1578017596


NPI Information

NPI: 1578017596
Provider Name: MERCY CLINIC SPECIALISTS SERVICES-ILLINOIS LLC
Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

Address:
2227 VADALABENE DR STE 200
MARYVILLE, IL
ZIP 62062
Phone: (314) 364-4347
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MERCY CLINIC SPECIALISTS SERVICES-ILLINOIS LLC is a hematology and oncology internal medicine in Maryville, IL. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. MERCY CLINIC SPECIALISTS SERVICES-ILLINOIS LLC NPI is 1578017596. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2227 VADALABENE DR STE 200
MARYVILLE, IL
ZIP 62062-824
Phone: (314) 364-4347

The provider's authorized official is Jeffrey Ciaramita .
The authorized official title is President and has the following contact phone number (314) 525-1785.

The enumeration date for this NPI number is 8/8/2016 and was last updated on 9/12/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1500051406MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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