Provider Demographics
NPI:1922114792
Name:NORTH IOWA MERCY CLINICS
Entity Type:Organization
Organization Name:NORTH IOWA MERCY CLINICS
Other - Org Name:MERCYONE FOREST PARK FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-428-7989
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:1010 4TH ST SW STE 120
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2856
Practice Address - Country:US
Practice Address - Phone:641-428-6020
Practice Address - Fax:641-428-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0221689Medicaid
IA47797OtherWELLMARK
IA0221689Medicaid