Healthcare Provider Details

I. General information

NPI: 1265472526
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/26/2015
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: 319-398-6509
Mailing address:
  • Phone: 319-398-6011
  • Fax: 319-398-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number570036H
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier160079
Identifier TypeOTHER
Identifier State
Identifier IssuerCOVENTRY HEALTH CARE
# 2
IdentifierA5240306
Identifier TypeOTHER
Identifier State
Identifier IssuerJOHN DEERE HEALTH PLAN
# 3
Identifier65046
Identifier TypeOTHER
Identifier State
Identifier IssuerWELLMARK, BLUE CROSS
# 4
Identifier0650461
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

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