Provider Demographics
NPI:1912950239
Name:MERCY HOME INFUSION PHARMACY
Entity Type:Organization
Organization Name:MERCY HOME INFUSION PHARMACY
Other - Org Name:MERCY MEDICAL CENTER-NORTH IOWA
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-428-5732
Mailing Address - Street 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-428-5732
Mailing Address - Fax:641-428-7431
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-428-5732
Practice Address - Fax:641-428-7431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER-NORTH IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1369251F00000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40932OtherWELLMARK-BCBS
IA0015252Medicaid
IA0015252Medicaid
0709250022Medicare PIN