Provider Demographics
NPI:1962591370
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:ASST TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-428-7984
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 1:621 S ILLINOIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5489
Practice Address - Country:US
Practice Address - Phone:641-428-6940
Practice Address - Fax:641-428-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA11383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0230789Medicaid
2030058OtherPK
IA0709250022Medicare NSC