Basic Information
| Provider Information | |||||||||
| NPI: | 1245994193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY PHYSICIAN ASSOCIATES, INC | ||||||||
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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: | 1220 1ST AVE NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524025008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193998617 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | QUINN | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3193986560 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.