Provider Demographics
NPI:1467511857
Name:MERCY THERAPEUTIC RADIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MERCY THERAPEUTIC RADIOLOGY ASSOCIATES LLC
Other - Org Name:MERCY CANCER CENTER RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/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 816
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50304-0816
Mailing Address - Country:US
Mailing Address - Phone:515-643-5168
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE C 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-643-5168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI4468Medicare PIN