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	310-800	WI

General Provider Information

NPI Number	:	1750551362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH SYSTEM CORPORATION

Provider Business Mailing Address
First Line	:	330 W TERRA COTTA AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3552
Country	:	US
Telephone Number	:	815-455-1751
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 W TERRA COTTA AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3552
Country	:	US
Telephone Number	:	815-455-1751
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	10/16/2009

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Directions to “MERCY HEALTH SYSTEM CORPORATION ” Practice Location

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