Healthcare Provider Details

I. General information

NPI: 1154490779
Provider Name (Legal Business Name): MERCY PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SIEGEL ST
TAMA IA
52339-2302
US

IV. Provider business mailing address

PO BOX 1824
CEDAR RAPIDS IA
52406
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-3333
  • Fax: 319-369-4677
Mailing address:
  • Phone: 319-369-4505
  • Fax: 319-369-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE J STANTON
Title or Position: SR DIRECTOR
Credential:
Phone: 319-369-4512