Provider Demographics
NPI:1598718603
Name:MERCY HEALTH SYSTEM CORPORATION
Entity Type:Organization
Organization Name:MERCY HEALTH SYSTEM CORPORATION
Other - Org Name:MHS PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-971-6752
Mailing Address - Street 1:PO BOX 5081
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-5081
Mailing Address - Country:US
Mailing Address - Phone:608-741-7630
Mailing Address - Fax:608-741-6890
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2984
Practice Address - Country:US
Practice Address - Phone:608-741-7630
Practice Address - Fax:608-741-6890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32796500Medicaid
IL5621473OtherBCBSIL
WI32796500Medicaid
IL5621473OtherBCBSIL
IL203745Medicare Oscar/Certification
IL476690Medicare Oscar/Certification
IL795140Medicare Oscar/Certification
WI000054390Medicare Oscar/Certification
WI000054176Medicare Oscar/Certification
WI000025095Medicare Oscar/Certification
IL208309Medicare Oscar/Certification
IL510420Medicare Oscar/Certification
WI000030340Medicare Oscar/Certification
IL5621473OtherBCBSIL
WI32796500Medicaid
IL214660Medicare Oscar/Certification
WI=========027OtherBCBSWI
WI000032345Medicare Oscar/Certification
WI000065105Medicare Oscar/Certification
IL210492Medicare Oscar/Certification