Basic Information
| Provider Information | |||||||||
| NPI: | 1235464132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY PHYSICIAN ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCYCARE NEONATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1824 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524061824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193694505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 10TH ST SE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524031251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192218618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2009 | ||||||||
| LastUpdateDate: | 10/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | STANTON | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3193694512 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.