Provider Demographics
NPI:1649349804
Name:MERCY CLINIC CHILDREN'S SURGERY, LLC
Entity type:Organization
Organization Name:MERCY CLINIC CHILDREN'S SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-364-3707
Mailing Address - Street 1:621 S. NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 6018-B
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8274
Mailing Address - Country:US
Mailing Address - Phone:314-251-5940
Mailing Address - Fax:314-251-5813
Practice Address - Street 1:621 S. NEW BALLAS ROAD
Practice Address - Street 2:SUITE 6018-B
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8274
Practice Address - Country:US
Practice Address - Phone:314-251-5940
Practice Address - Fax:314-251-5813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CLINIC EAST COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty