Provider Demographics
NPI:1265458723
Name:MERCY CLINICS INC
Entity Type:Organization
Organization Name:MERCY CLINICS INC
Other - Org Name:MERCY INDIANOLA DETROIT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIESKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-643-7150
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4374
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:112 E DETROIT AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1860
Practice Address - Country:US
Practice Address - Phone:515-961-5324
Practice Address - Fax:515-961-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3207084Medicaid
IACD3776OtherRAILROAD MEDICARE
IACD3776OtherRAILROAD MEDICARE