Provider Demographics
NPI:1003912171
Name:SACRED HEART MERCY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:SACRED HEART MERCY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER CECELIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCADUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-847-3571
Mailing Address - Street 1:803 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1056
Mailing Address - Country:US
Mailing Address - Phone:507-847-3571
Mailing Address - Fax:507-847-5664
Practice Address - Street 1:803 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1056
Practice Address - Country:US
Practice Address - Phone:507-847-3571
Practice Address - Fax:507-847-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN49777COOtherBLUE CROSS BLUE SHIELD OF
MN112054OtherUCARE MINNESOTA
MNC07359Medicare ID - Type Unspecified