Provider Demographics
NPI:1316909484
Name:MERCY HEALTH SERVICES-IOWA CORP
Entity type:Organization
Organization Name:MERCY HEALTH SERVICES-IOWA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MARKET CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BOORE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-428-7349
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1159
Mailing Address - Country:US
Mailing Address - Phone:641-428-7917
Mailing Address - Fax:641-428-8635
Practice Address - Street 1:98 10TH ST N
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:IA
Practice Address - Zip Code:50459-1438
Practice Address - Country:US
Practice Address - Phone:641-324-2116
Practice Address - Fax:641-324-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA5463336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316909484Medicaid
MN332060000Medicaid
2026324OtherPK
IA0128157Medicaid