Healthcare Provider Details
I. General information
NPI: 1528388998
Provider Name (Legal Business Name): MERCY CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/08/2010
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1601 NW 114TH ST SUITE 342
CLIVE IA
50325-7036
US
IV. Provider business mailing address
PO BOX 1475
DES MOINES IA
50305-1475
US
V. Phone/Fax
- Phone: 515-222-7600
- Fax:
- Phone: 515-222-7600
- Fax: 515-222-7643
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
BRADLEY
WHIPPLE
Title or Position: COO
Credential:
Phone: 515-358-6956