Provider Demographics
NPI:1316985252
Name:MERCY MEDICAL SERVICES
Entity type:Organization
Organization Name:MERCY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE NETWORK DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-2925
Mailing Address - Street 1:212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEEMER
Mailing Address - State:NE
Mailing Address - Zip Code:68716-4214
Mailing Address - Country:US
Mailing Address - Phone:402-528-3288
Mailing Address - Fax:402-528-3660
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEEMER
Practice Address - State:NE
Practice Address - Zip Code:68716-4214
Practice Address - Country:US
Practice Address - Phone:402-528-3288
Practice Address - Fax:402-528-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========33Medicaid
NE092209Medicare PIN
NE28-3817Medicare ID - Type UnspecifiedRIVERBEND - FACILITY ID