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General NPI Number Information
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NPI Number | 1669685129
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH SYSTEM CORPORATION
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 903 MINERAL POINT AVE
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City | JANESVILLE
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State | WI
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Zip | 53548-2970
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Country | US
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Telephone | 608-756-5555
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Fax | 608-756-0174
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Provider Business Mailing Address
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Address Line | 1000 MINERAL POINT AVE
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City | JANESVILLE
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State | WI
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Zip | 53548
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Country | US
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Telephone | 608-756-6000
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Fax |
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Authorized Official
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Title or Position | CFO AUTHORIZED OFFICIAL
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Name | JOSEPH D MALAS
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Credential |
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Telephone | 815-971-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 310-800
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 310-800
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 310-800
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 310-800
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 310800
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License Number State | WI
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