Healthcare Provider Details

I. General information

NPI: 1366039067
Provider Name (Legal Business Name): MERCY HEALTH SYSTEM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W MAIN ST
WHITEWATER WI
53190-1852
US

IV. Provider business mailing address

1000 MINERAL POINT AVE
JANESVILLE WI
53548-2940
US

V. Phone/Fax

Practice location:
  • Phone: 262-473-0400
  • Fax: 262-473-0408
Mailing address:
  • Phone: 608-756-6000
  • Fax:

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: TODD ANDERSON
Title or Position: VP CFO
Credential:
Phone: 815-971-6752