Provider Demographics
NPI:1386832764
Name:MERCY SPECIALTY CLINIC
Entity type:Organization
Organization Name:MERCY SPECIALTY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/CNO
Authorized Official - Prefix:
Authorized Official - First Name:MELLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-244-5608
Mailing Address - Street 1:1410 NORTH 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2940
Mailing Address - Country:US
Mailing Address - Phone:563-244-5900
Mailing Address - Fax:563-244-5901
Practice Address - Street 1:1410 NORTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2940
Practice Address - Country:US
Practice Address - Phone:563-244-5900
Practice Address - Fax:563-244-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71222OtherWELLMARK
IADG7041OtherRR MEDICARE
IA1386832764Medicaid
DG7041OtherRAILROAD MEDICARE
DG7041OtherRAILROAD MEDICARE
IA1386832764Medicaid
IL215957Medicare PIN