Provider Demographics
NPI:1821134826
Name:ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA
Entity Type:Organization
Organization Name:ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA
Other - Org Name:CHI HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM SVP
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-343-4477
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:ATTN LISA SMITH
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:
Practice Address - Street 1:601 ROSARY DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:IA
Practice Address - Zip Code:50841-1683
Practice Address - Country:US
Practice Address - Phone:641-322-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41473Medicare PIN
IA21536Medicare PIN
IA41469Medicare PIN
041911Medicare Oscar/Certification
IA021536Medicare PIN
041469Medicare Oscar/Certification
041473Medicare Oscar/Certification
IA041469Medicare PIN