Provider Demographics
NPI:1154321404
Name:MERCY HOSPITAL OF FRANCISCAN SISTERS
Entity Type:Organization
Organization Name:MERCY HOSPITAL OF FRANCISCAN SISTERS
Other - Org Name:MERCY HOSPITAL ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:952-442-9770
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:201 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2447
Practice Address - Country:US
Practice Address - Phone:319-283-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105345207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN67M83MEOtherBLUE CROSS MN CC SYST
IA0101972Medicaid
MN67M83MEOtherBLUE CROSS MN CC SYST
IAI10851Medicare ID - Type Unspecified
=========012Medicare ID - Type UnspecifiedRAILROAD MEDICARE