1871725358 NPI number — MERCY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871725358 NPI number — MERCY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL CENTER
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 VINTON DIALYSIS
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:
1871725358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 10TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-398-6011
Provider Business Mailing Address Fax Number:
319-398-6509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 N 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52349-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-472-6359
Provider Business Practice Location Address Fax Number:
319-398-6509
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLES
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
319-398-6697

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1871725358 . This is a "WELLMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1871725358 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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