Provider Demographics
NPI:1093360679
Name:MERCY MEDICAL CENTER-CENTERVILLE
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-CENTERVILLE
Other - Org Name:MERCYONE OTTUMWA FAMILY AND INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-437-3413
Mailing Address - Street 1:1 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-9017
Mailing Address - Country:US
Mailing Address - Phone:641-437-3413
Mailing Address - Fax:
Practice Address - Street 1:522 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4231
Practice Address - Country:US
Practice Address - Phone:641-683-0800
Practice Address - Fax:641-683-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health