1083649206 NPI number — MERCY MEDICAL CENTER-DUBUQUE

Table of content: (NPI 1083649206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083649206 NPI number — MERCY MEDICAL CENTER-DUBUQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL CENTER-DUBUQUE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MERCYONE DUBUQUE MEDICAL CENTER-SKILLED NURSING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083649206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 MERCY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-7320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-589-8000
Provider Business Mailing Address Fax Number:
563-589-9029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 MERCY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-589-8000
Provider Business Practice Location Address Fax Number:
563-589-9029
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAKES
Authorized Official First Name:
KAY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
563-589-8061

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  310003H , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65116 . This is a "BLUE CROSS SKILLED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0651166 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A000957 . This is a "TRICARE/CHAMPUS SKILLED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com