Provider Demographics
NPI:1275875502
Name:CATHOLIC HEALTH INITIATIVES - IOWA CORP
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES - IOWA CORP
Other - Org Name:MERCY MEDICAL CENTER - DES MOINES D/B/A MERCY FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:VELLINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-247-4278
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50303-0645
Mailing Address - Country:US
Mailing Address - Phone:515-643-4610
Mailing Address - Fax:
Practice Address - Street 1:250 LAUREL ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3024
Practice Address - Country:US
Practice Address - Phone:515-643-4610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES - IOWA CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty