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General NPI Number Information
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NPI Number | 1003912171
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Entity Type | Organization
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Legal Business Name | SACRED HEART MERCY HEALTH CARE CENTER
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 803 4TH ST
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City | JACKSON
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State | MN
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Zip | 56143-1056
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Country | US
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Telephone | 507-847-3571
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Fax | 507-847-5664
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Provider Business Mailing Address
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Address Line | 803 4TH ST
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City | JACKSON
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State | MN
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Zip | 56143-1056
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Country | US
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Telephone | 507-847-3571
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Fax | 507-847-5664
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SISTER CECELIA MARIE SCADUTO
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Credential |
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Telephone | 507-847-3571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35741
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License Number State | MN
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