Provider Demographics
NPI:1255484903
Name:MERCY MEDICAL CENTER-CENTERVILLE
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-CENTERVILLE
Other - Org Name:MERCYONE CENTERVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
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:641-437-4111
Mailing Address - Fax:641-437-3422
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-9017
Practice Address - Country:US
Practice Address - Phone:641-437-4111
Practice Address - Fax:641-437-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0049098Medicaid
IA1255484903Medicaid