Provider Demographics
NPI:1649334574
Name:ALEGENT HEALTH MERCY HOSPITAL CORNING, IOWA
Entity type:Organization
Organization Name:ALEGENT HEALTH MERCY HOSPITAL CORNING, IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4409
Mailing Address - Street 1:603 ROSARY DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841-1683
Mailing Address - Country:US
Mailing Address - Phone:641-322-5245
Mailing Address - Fax:
Practice Address - Street 1:603 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:2006-12-22
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41469OtherMEDICARE PTAN
IA21536OtherMEDICARE PTAN
IA41473OtherMEDICARE PTAN