MEDICARE: MERCY SERVICES IOWA CITY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1457863318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY SERVICES IOWA CITY, INC.

Provider Business Mailing Address
First Line	:	1486 S 1ST AVE STE B
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6072
Country	:	US
Telephone Number	:	319-339-3992
Fax Number	:	319-358-2628

Provider Business Practice Location Address
First Line	:	402 S WALNUT ST
Second Line	:
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-9559
Country	:	US
Telephone Number	:	319-664-3211
Fax Number	:	319-664-3212

Authorized Official
Title or Position	:	PROJECTS & MEMBER SERVICES COORD
Name	:	DONNA L FORD
Credential	:
Telephone Number	:	319-339-3993

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	01/27/2020

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