Healthcare Provider Details

I. General information

NPI: 1427254952
Provider Name (Legal Business Name): MERCY PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 EDGEWOOD RD SW
CEDAR RAPIDS IA
52404-3258
US

IV. Provider business mailing address

PO BOX 1824
CEDAR RAPIDS IA
52406-1824
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-4798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0148049
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: ANNETTE J STANTON
Title or Position: SR DIRECTOR
Credential:
Phone: 319-369-4512