Provider Demographics
NPI:1730664566
Name:MERCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:MERCY MEDICAL SERVICES
Other - Org Name:MERCYONE CHEROKEE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLANTYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-428-3086
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3086
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:212 E BOW DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1215
Practice Address - Country:US
Practice Address - Phone:712-225-6431
Practice Address - Fax:641-428-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty