Organization
MERCY HEALTH SYSTEM CORPORATION
Active
Parent organization
MERCY ALLIANCE INC
Other names
MERCY CRYSTAL LAKE OB GYN
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY ALLIANCE INC
Authorized official
JOHN W COOK (VP CFO)
(608) 756-6000
Entity
Organization
Contact information
Practice address
750 E TERRA COTTA AVE, STE B, CRYSTAL LAKE, IL 60014-3621
(815) 459-1212
Mailing address
1000 MINERAL POINT AVE, JANESVILLE, WI 53548-2940
(608) 756-6000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
310800
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D0411934
CLIA
—
Enumeration date
03/23/2007
Last updated
01/06/2009
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