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General NPI Number Information
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NPI Number | 1427404953
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Entity Type | Organization
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Legal Business Name | MERCY PHYSICIAN ASSOCIATES INC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 4659 HIGHWAY 13
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City | CENTRAL CITY
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State | IA
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Zip | 52214-9804
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Country | US
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Telephone | 319-438-1046
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Fax | 319-438-1048
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Provider Business Mailing Address
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Address Line | PO BOX 1824
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City | CEDAR RAPIDS
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State | IA
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Zip | 52406-1824
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Country | US
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Telephone | 319-438-1046
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Fax | 319-438-1048
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | TIMOTHY CHARLES
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Credential |
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Telephone | 319-398-6697
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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 |
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License Number State |
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