Healthcare Provider Details

I. General information

NPI: 1316909484
Provider Name (Legal Business Name): MERCY HEALTH SERVICES-IOWA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 10TH ST N
NORTHWOOD IA
50459-1438
US

IV. Provider business mailing address

PO BOX 1159
MASON CITY IA
50402-1159
US

V. Phone/Fax

Practice location:
  • Phone: 641-324-2116
  • Fax: 641-324-1032
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 Number546
License Number StateIA

VIII. Authorized Official

Name: BOORE CHAD
Title or Position: MARKET CHIEF OPERATING OFFICER
Credential:
Phone: 641-428-7349