Provider Demographics
NPI:1639119332
Name:MERCY MEDICAL CENTER
Entity type:Organization
Organization Name:MERCY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-398-6697
Mailing Address - Street 1:701 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-398-6011
Mailing Address - Fax:319-398-6509
Practice Address - Street 1:2740 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4856
Practice Address - Country:US
Practice Address - Phone:319-398-6034
Practice Address - Fax:319-398-6364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA570036H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
A5240306OtherJOHN DEERE HEALTH CARE
IA0671511Medicaid
=========OtherGREAT-WEST HEALTHCRE
A5240306OtherJOHN DEERE HEALTH CARE
A5240306OtherJOHN DEERE HEALTH CARE