Provider Demographics
NPI:1093845737
Name:MERCY MEDICAL CENTER-CLINTON, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-CLINTON, INC.
Other - Org Name:MERCYONE CLINTON MEDICAL CENTER DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8061
Mailing Address - Street 1:638 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4742
Mailing Address - Country:US
Mailing Address - Phone:563-244-5676
Mailing Address - Fax:563-244-5592
Practice Address - Street 1:638 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4742
Practice Address - Country:US
Practice Address - Phone:563-244-5676
Practice Address - Fax:563-244-5592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA230056H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA162313Medicare Oscar/Certification