Healthcare Provider Details

I. General information

NPI: 1720026461
Provider Name (Legal Business Name): MERCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E 14TH ST
WAYNE NE
68787-1152
US

IV. Provider business mailing address

PO BOX 328
SIOUX CITY IA
51102-0328
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-2500
  • Fax: 402-375-2463
Mailing address:
  • Phone: 712-279-5830
  • Fax: 712-279-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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