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CAH161377-02 MercyOne Centerville Medical Center (Active)
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Main Details
Name
MercyOne Centerville Medical Center
Subdivision Name
MERCY MEDICAL CENTER-CENTERVILLE - MercyOne Ottumwa Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161377-02
Medicare Provider Number
161377
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/20/2021
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
MercyOne Centerville Medical Center
Nicole Clapp, President
(641) 437-3410
Primary Contact
Mercy Medical Center-Centerville
JEFF WILLIER, DIRECTOR OF PHARMACY
(641) 437-3442
Addresses
Street Address
522 N HANCOCK ST
MERCYONE OTTUMWA FAMILY AND INTERNAL MEDICINE CLIN
OTTUMWA, IA 52501-4231
Billing Address
MercyOne Centerville Medical Center
1 St Joseph Drive
Department of Pharmacy
Centerville, IA 52544
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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