Healthcare Provider Details

I. General information

NPI: 1205023868
Provider Name (Legal Business Name): MERCY MEDICAL CENTER-CENTERVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ST. JOSEPH'S DRIVE
CENTERVILLE IA
52544
US

IV. Provider business mailing address

1 ST. JOSEPH'S DRIVE
CENTERVILLE IA
52544
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0163667
License Number StateIA

VIII. Authorized Official

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