Provider Demographics
NPI:1891833877
Name:MERCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:MERCY MEDICAL SERVICES
Other - Org Name:KINGSLEY MERCY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NETWORK EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MONSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-2400
Mailing Address - Street 1:801 5TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1326
Mailing Address - Country:US
Mailing Address - Phone:712-279-2400
Mailing Address - Fax:712-279-5883
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:STE 201
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2400
Practice Address - Fax:712-279-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAWELLMARK BCBS IAOther12293