Healthcare Provider Details

I. General information

NPI: 1134161151
Provider Name (Legal Business Name): MERCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PIERCE ST
SIOUX CITY IA
51105-1485
US

IV. Provider business mailing address

PO BOX 1836
SIOUX CITY IA
51102-1836
US

V. Phone/Fax

Practice location:
  • Phone: 712-258-6780
  • Fax: 712-279-5883
Mailing address:
  • Phone: 712-279-5830
  • Fax: 712-279-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIAN K. MONSMA
Title or Position: EXECUTIVE NETWORK DIRECTOR
Credential:
Phone: 712-279-2925