Provider Demographics
NPI:1124089347
Name:MERCY HOSPITAL, IOWA CITY, IOWA
Entity type:Organization
Organization Name:MERCY HOSPITAL, IOWA CITY, IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-339-3540
Mailing Address - Street 1:500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2633
Mailing Address - Country:US
Mailing Address - Phone:319-339-3992
Mailing Address - Fax:319-358-2628
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-339-3452
Practice Address - Fax:319-339-3906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL, IOWA CITY, IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0127415Medicaid
IA12741OtherBLUE CROSS BLUE SHIELD
IA12741OtherBLUE CROSS BLUE SHIELD