MEDICARE: MERCY HEALTH SYSTEM CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	310800	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14D0951924	OTHER		CLIA

General Provider Information

NPI Number	:	1417073396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH SYSTEM CORPORATION

Provider Business Mailing Address
First Line	:	1000 MINERAL POINT AVE
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53548-2940
Country	:	US
Telephone Number	:	608-756-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9715 PRAIRIE RDG
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9112
Country	:	US
Telephone Number	:	815-678-4528
Fax Number	:

Authorized Official
Title or Position	:	VP CFO
Name	:	JOHN W COOK
Credential	:
Telephone Number	:	608-756-6000

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/20/2009

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Directions to “MERCY HEALTH SYSTEM CORPORATION ” Practice Location

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