1154321404 NPI number — MERCY HOSPITAL OF FRANCISCAN SISTERS

Table of content: (NPI 1154321404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154321404 NPI number — MERCY HOSPITAL OF FRANCISCAN SISTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL OF FRANCISCAN SISTERS
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:
MERCY HOSPITAL ANESTHESIA
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:
1154321404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-9770
Provider Business Mailing Address Fax Number:
952-442-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 8TH AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OELWEIN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50662-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-283-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COMEAU
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
952-442-9770

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  105345 , 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: 67M83ME . This is a "BLUE CROSS MN CC SYST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0101972 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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