1972610376 NPI number — NORTH IOWA MERCY CLINICS

Table of content: (NPI 1972610376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972610376 NPI number — NORTH IOWA MERCY CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IOWA MERCY CLINICS
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 NORTH IOWA CANCER 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:
1972610376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 S ILLINOIS AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-5489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-428-3041
Provider Business Mailing Address Fax Number:
641-428-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 4TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-428-6300
Provider Business Practice Location Address Fax Number:
641-428-6374
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZOOK
Authorized Official First Name:
DANETTE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP FIANANCE
Authorized Official Telephone Number:
641-428-7898

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0238360 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13845 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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