Healthcare Provider Details

I. General information

NPI: 1467511857
Provider Name (Legal Business Name): MERCY THERAPEUTIC RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST SUITE C 100
DES MOINES IA
50314-3017
US

IV. Provider business mailing address

PO BOX 816
DES MOINES IA
50304-0816
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-5168
  • Fax:
Mailing address:
  • Phone: 515-643-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID H VELLINGA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 515-247-4278