Healthcare Provider Details

I. General information

NPI: 1255886388
Provider Name (Legal Business Name): MERCY PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 76TH AVENUE DR SW
CEDAR RAPIDS IA
52404-7006
US

IV. Provider business mailing address

PO BOX 1824
CEDAR RAPIDS IA
52406-1824
US

V. Phone/Fax

Practice location:
  • Phone: 319-558-0350
  • Fax: 319-558-0351
Mailing address:
  • Phone: 319-558-0350
  • Fax: 319-558-0351

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY DEWOLF
Title or Position: INTERIM PRESIDENT & CEO
Credential:
Phone: 319-398-6101