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NPI Code Detail

MEDICARE: MERCY PHYSICIAN ASSOCIATES, INC

MEDICARE: MERCY PHYSICIAN ASSOCIATES, INC
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
1363LF0000XFamily Nurse Practitioner
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417153941
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY PHYSICIAN ASSOCIATES, INC
Provider Business Mailing Address
First Line : PO BOX 1824
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52406-1824
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3933 MOUNT VERNON RD SE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52403-3869
Country : US
Telephone Number : 319-369-4798
Fax Number :
Authorized Official
Title or Position : SR DIRECTOR
Name : ANNETTE J STANTON
Credential :
Telephone Number : 319-369-4512
Provider Enumeration Date : 06/22/2007
Last Update Date : 07/12/2016

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Directions to “MERCY PHYSICIAN ASSOCIATES, INC ” Practice Location

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