Provider Demographics
NPI:1205816725
Name:MERCY MEDICAL CENTER-DYERSVILLE
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-DYERSVILLE
Other - Org Name:MERCYONE DYERSVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8061
Mailing Address - Street 1:250 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7320
Mailing Address - Country:US
Mailing Address - Phone:563-589-9086
Mailing Address - Fax:563-589-9029
Practice Address - Street 1:1111 3RD ST SW
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1725
Practice Address - Country:US
Practice Address - Phone:563-875-7101
Practice Address - Fax:563-875-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310181H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0601542Medicaid
310181HOtherLICENSE
IA0601542Medicaid