1215950142 NPI number — MERCY CLINICS INC

Table of content: (NPI 1215950142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215950142 NPI number — MERCY CLINICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY CLINICS INC
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 CAPITOL EAST DES MOINES CLINIC
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:
1215950142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50305-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-643-4374
Provider Business Mailing Address Fax Number:
515-643-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-5515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-265-5355
Provider Business Practice Location Address Fax Number:
515-265-1551
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWIESKOWSKI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
515-643-7150

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0420323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD3776 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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