Organization
MERCY MEDICAL CENTER
Active
Other names
Mercy Vinton Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY L CHARLES (PRESIDENT AND CEO)
(319) 398-6697
Entity
Organization
Contact information
Practice address
502 N 9TH AVE, VINTON, IA 52349-2254
(319) 472-6359
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871725358
WELLMARK
—
05
—
1871725358
—
IA
Enumeration date
08/17/2009
Last updated
07/21/2010
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