MERCY MEDICAL SERVICES
Clinical Neuropsychologist
Sioux City, Iowa
Provider NPI: 1356389423
Organization Information:Organization Name: MERCY MEDICAL SERVICES
Organization is not Subpart
Authorized Official: BRIAN K. MONSMA EXECUTIVE NETWORK DIRECTOR 712-2792925
Practice Location:
801 5TH ST SUITE 201 SIOUX CITY, IA 51101 US
Tel: 712-279-2925 Fax: 712-279-5883
Business Mailing Address:
PO BOX 328 SIOUX CITY, IA 51102 US
Tel: 712-279-5830 Fax: 712-279-5883
Entity Type: Organization
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Organization is not Subpart
Authorized Official: BRIAN K. MONSMA EXECUTIVE NETWORK DIRECTOR 712-2792925
Practice Location:
801 5TH ST SUITE 201 SIOUX CITY, IA 51101 US
Tel: 712-279-2925 Fax: 712-279-5883
Business Mailing Address:
PO BOX 328 SIOUX CITY, IA 51102 US
Tel: 712-279-5830 Fax: 712-279-5883
Entity Type: Organization
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | ||
N | 103T00000X | Behavioral Health & Social Service Providers Psychologist | ||
N | 208100000X | Physicians Physical Medicine & Rehabilitation | ||
Y | 2084N0400X | Physicians Psychiatry & Neurology |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
0421990 | IA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin