1952327470 NPI number — MERCY CLINICS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952327470 NPI number — MERCY CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY CLINICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952327470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50305-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-643-9400
Provider Business Mailing Address Fax Number:
515-643-9405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6601 SW 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50315-6138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-643-9400
Provider Business Practice Location Address Fax Number:
515-643-9405
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHIPPLE
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
515-358-6956

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CD3776 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0120444 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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