Provider Demographics
NPI:1164629937
Name:MERCY PHYSICIAN ASSOCIATES, INC
Entity Type:Organization
Organization Name:MERCY PHYSICIAN ASSOCIATES, INC
Other - Org Name:MERCY CARE NORTH LIBERTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-369-4512
Mailing Address - Street 1:PO BOX 1824
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1765 LININGER LANE
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-369-4798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0792606Medicaid
IA0792606Medicaid