Provider Demographics
NPI:1740220490
Name:CATHOLIC HEALTH INITIATIVES-IOWA CORP
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES-IOWA CORP
Other - Org Name:MERCYONE DES MOINES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-247-4273
Mailing Address - Street 1:1111 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2613
Mailing Address - Country:US
Mailing Address - Phone:515-643-4429
Mailing Address - Fax:515-643-8965
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-643-4429
Practice Address - Fax:515-643-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA5933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0212449Medicaid
2027961OtherPK
IA0212449Medicaid