Basic Information
| Provider Information | |||||||||
| NPI: | 1306880570 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAUM HARMON MERCY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRIMGHAR MERCY MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 477 | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512457786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7129572310 | ||||||||
| FaxNumber: | 7129572300 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 NORTH RERICK AVE | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7129572310 | ||||||||
| FaxNumber: | 7129570504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHIERHOLZ | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BOARD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7123631075 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 0634980 | 05 | IA | MEDICAID |