Healthcare Provider Details

I. General information

NPI: 1154321404
Provider Name (Legal Business Name): MERCY HOSPITAL OF FRANCISCAN SISTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 8TH AVE SE
OELWEIN IA
50662-2447
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 319-283-6000
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number105345
License Number StateIA

VIII. Authorized Official

Name: TIMOTHY HUBER
Title or Position: CFO
Credential:
Phone: 319-272-7607