Healthcare Provider Details

I. General information

NPI: 1184891970
Provider Name (Legal Business Name): MERCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 5TH ST SUITE 201
SIOUX CITY IA
51101-1326
US

IV. Provider business mailing address

PO BOX 328
SIOUX CITY IA
51102-0328
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-2400
  • Fax: 712-279-5883
Mailing address:
  • Phone: 712-279-5830
  • Fax: 712-279-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CLARK
Title or Position: PRESIDENT
Credential:
Phone: 712-279-2018