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
1	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1811193352
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	:	900 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9477
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	:	02/01/2011

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