Provider Demographics
NPI:1750078200
Name:MERCYONE - KRHC HOME MEDICAL SHOP LLC
Entity type:Organization
Organization Name:MERCYONE - KRHC HOME MEDICAL SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-428-7984
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 S PHILLIPS ST STE 1
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3649
Practice Address - Country:US
Practice Address - Phone:515-295-4452
Practice Address - Fax:515-295-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies