Healthcare Provider Details

I. General information

NPI: 1083664361
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: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19898 SAINT JOSEPH DRIVE
CENTERVILLE IA
52544-9088
US

IV. Provider business mailing address

1 SAINT JOSEPH DRIVE
CENTERVILLE IA
52544-9088
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: PAM YOUNG
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 641-437-3413