Healthcare Provider Details

I. General information

NPI: 1013953504
Provider Name (Legal Business Name): MERCY HEALTH SYSTEM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S JANESVILLE ST
MILTON WI
53563-1775
US

IV. Provider business mailing address

1010 N WASHINGTON ST
JANESVILLE WI
53548-1561
US

V. Phone/Fax

Practice location:
  • Phone: 608-868-6777
  • Fax: 608-868-4177
Mailing address:
  • Phone: 608-868-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7665
License Number StateWI

VIII. Authorized Official

Name: JOSEPH D MALAS
Title or Position: CFO
Credential:
Phone: 815-971-6738