Healthcare Provider Details

I. General information

NPI: 1578511069
Provider Name (Legal Business Name): MERCY PHYSICIAN ASSOCIATES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 8TH ST SE
CEDAR RAPIDS IA
52401-2143
US

IV. Provider business mailing address

PO BOX 1824
CEDAR RAPIDS IA
52406-1824
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-4505
  • Fax: 319-369-4677
Mailing address:
  • Phone: 319-369-4505
  • Fax: 319-369-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
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:

VIII. Authorized Official

Name: TEDD KIPPER
Title or Position: DIRECTOR
Credential:
Phone: 319-369-4505