Provider Demographics
NPI:1659348506
Name:MERCY MEDICAL CENTER-DUBUQUE
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-DUBUQUE
Other - Org Name:MERCYONE DUBUQUE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8061
Mailing Address - Street 1:250 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7320
Mailing Address - Country:US
Mailing Address - Phone:563-589-8000
Mailing Address - Fax:563-589-9005
Practice Address - Street 1:250 MERCY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7320
Practice Address - Country:US
Practice Address - Phone:563-589-8000
Practice Address - Fax:563-589-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310003H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600692Medicaid
IAA000957OtherTRICARE/CHAMPUS
WI11002500Medicaid
IA600692OtherBLUE CROSS
MN0106073Medicaid
WI11002500Medicaid
IA0600692Medicaid
WI11002500Medicaid
IAI7915Medicare PIN