NPIMap

Organization Active NPI

Southeast Hospital

  • Community/Retail Pharmacy
  • Jackson, MO
National Provider Identifier
1942847413
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SOUTHEAST HOSPITAL
Doing business as
MERCY PHARMACY JACKSON
Practice address
2600 E. Main Street
Suite 113
Jackson, MO 63755
Phone
(573) 755-2315
Fax
(573) 519-4676
NPI assigned
Dec 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Krista Berry
Title
Cfo
Phone
(573) 331-6028

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

2600 E. Main Street
Suite 113
Jackson, MO 63755

Mailing address

2600 E. Main Street
Suite 113
Jackson, MO 63755
Phone (573) 755-2315

Other names 1

  • MERCY PHARMACY JACKSON Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeast Mo Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2600 E Main St
Ste 113
Jackson, MO 63755
Phone (573) 755-2315

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1942847413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E. MAIN STREET",
            "address_2": "SUITE 113",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-755-2315",
            "fax_number": "573-519-4676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E. MAIN STREET",
            "address_2": "SUITE 113",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-755-2315",
            "fax_number": "573-519-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-04",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-6028",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY PHARMACY JACKSON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.