Provider Demographics
NPI:1356391635
Name:MERCY MEDICAL CENTER-CENTERVILLE
Entity type:Organization
Organization Name:MERCY MEDICAL CENTER-CENTERVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - MERCY CENTERVILLE MEDIC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-437-3410
Mailing Address - Street 1:1 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-9017
Mailing Address - Country:US
Mailing Address - Phone:641-437-3410
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-9017
Practice Address - Country:US
Practice Address - Phone:641-437-4111
Practice Address - Fax:641-437-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACD4303OtherRR MEDICARE
IA60020OtherWELLMARK
IA0600205Medicaid
IACD4303OtherRR MEDICARE