Healthcare Provider Details

I. General information

NPI: 1982300349
Provider Name (Legal Business Name): NORTH IOWA MERCY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EISENHOWER AVE
MASON CITY IA
50401-1552
US

IV. Provider business mailing address

1000 4TH ST SW
MASON CITY IA
50401-2800
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-5911
  • Fax: 641-428-5985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK TRAMMEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 641-428-7984