1316909484 NPI number — MERCY HEALTH SERVICES-IOWA CORP

Table of content: (NPI 1316909484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316909484 NPI number — MERCY HEALTH SERVICES-IOWA CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH SERVICES-IOWA CORP
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:
Provider Other Organization Name Type Code:
6
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:
1316909484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50402-1159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-428-7917
Provider Business Mailing Address Fax Number:
641-428-8635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 10TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHWOOD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50459-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-324-2116
Provider Business Practice Location Address Fax Number:
641-324-1032
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAD
Authorized Official First Name:
BOORE
Authorized Official Middle Name:
Authorized Official Title or Position:
MARKET CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
641-428-7349

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 546 , 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)





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