1427093962 NPI number — MERCY MEDICAL CENTER-CLINTON, INC

Table of content: (NPI 1427093962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427093962 NPI number — MERCY MEDICAL CENTER-CLINTON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL CENTER-CLINTON, 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:
MERCYONE CLINTON MEDICAL CENTER
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:
1427093962
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:
1410 N. 4TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52732-2940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-244-5555
Provider Business Mailing Address Fax Number:
563-244-5592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-2940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-244-5676
Provider Business Practice Location Address Fax Number:
563-244-5592
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  230056H , 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: 0600809 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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