Provider Demographics
NPI:1851611990
Name:MERCY MEDICAL CENTER-DUBUQUE
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER-DUBUQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
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 1:200 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-1230
Practice Address - Country:US
Practice Address - Phone:596-387-2598
Practice Address - Fax:563-589-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310003H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16006900Medicare PIN