Healthcare Provider Details

I. General information

NPI: 1497952170
Provider Name (Legal Business Name): MERCY PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 7TH ST SE STE 100
CEDAR RAPIDS IA
52401-2120
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
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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