Organization
MERCY MEDICAL CENTER
Active
Parent organization
MERCY MEDICAL CENTER
Other names
Mercy Health Plaza Dialysis
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY MEDICAL CENTER
Authorized official
MR. TIMOTHY CHARLES (PRESIDENT AND CEO)
(319) 398-6697
Entity
Organization
Contact information
Practice address
5264 COUNCIL ST NE, CEDAR RAPIDS, IA 52402-2471
(319) 398-6011
(319) 398-6509
Mailing address
701 10TH ST SE, CEDAR RAPIDS, IA 52403-1251
(319) 398-6011
(319) 398-6509
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
570036H
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0600791
—
IA
01
—
160079
COVENTRY HEALTH CARE
—
01
—
63514
WELLMARK BLUE CROSS
—
01
—
A5240306
JOHN DEERE HEALTH PLAN
—
Enumeration date
06/08/2006
Last updated
06/18/2009
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