Healthcare Provider Details

I. General information

NPI: 1003221979
Provider Name (Legal Business Name): MERCY HEALTH SERVICES-IOWA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E TRAER ST
GREENE IA
50636-7702
US

IV. Provider business mailing address

PO BOX 1159
MASON CITY IA
50402-1159
US

V. Phone/Fax

Practice location:
  • Phone: 641-816-3013
  • Fax: 641-816-3015
Mailing address:
  • Phone: 641-428-7917
  • Fax: 641-428-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1508
License Number StateIA

VIII. Authorized Official

Name: MARK TRAMMEL
Title or Position: ASST TREASURER
Credential:
Phone: 641-428-7984