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SCH160064-22 MERCY MEDICAL CENTER - NORTH IOWA (Terminated)
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Main Details
Name
MERCY MEDICAL CENTER - NORTH IOWA
Subdivision Name
Mercy Dialysis Center - Mason City
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH160064-22
Medicare Provider Number
160064
Outpatient Facility Provider Number
160064
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
1/1/2017
Change of covered entity type
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
DANETTE ZOOK, RHM VP Finance
(641) 428-7989
Primary Contact
Mercy Medical Center - North Iowa
Craig Osland, Director of Pharmacy
(641) 428-7605
Addresses
Street Address
910 N EISENHOWER AVE
MASON CITY, IA 50401-1525
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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