Healthcare Provider Details

I. General information

NPI: 1629024930
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1251
US

IV. Provider business mailing address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1251
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6011
  • Fax:
Mailing address:
  • Phone: 319-398-6011
  • Fax: 319-398-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number570036H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number570036H
License Number StateIA

VIII. Authorized Official

Name: MR. TIMOTHY CHARLES
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 319-398-6697