Healthcare Provider Details

I. General information

NPI: 1346290624
Provider Name (Legal Business Name): MERCY MEDICAL CENTER-CENTERVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
CENTERVILLE IA
52544-9088
US

IV. Provider business mailing address

1 SAINT JOSEPH DR
CENTERVILLE IA
52544-9088
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-3413
  • 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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CLAPP
Title or Position: PRESIDENT
Credential:
Phone: 641-437-3410