Provider Demographics
NPI:1437131018
Name:CATHOLIC HEALTH INITIATIVES-IOWA CORP.
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES-IOWA CORP.
Other - Org Name:MERCY SPECIALTY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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 1:1750 48TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1988
Mailing Address - Country:US
Mailing Address - Phone:515-271-6466
Mailing Address - Fax:515-271-6471
Practice Address - Street 1:1750 48TH ST
Practice Address - Street 2:STE 4
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1988
Practice Address - Country:US
Practice Address - Phone:515-271-6466
Practice Address - Fax:515-271-6471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-18
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1081333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0202986Medicaid
1620005OtherNABP
IA0202986Medicaid