Mercy Specialty Clinic
Organization Active NPI Family Medicine Physician · Fulton, IL
NPI 1487218079 · NPPES record last updated Oct 17, 2024
Key facts
- NPI
- 1487218079
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MERCY SPECIALTY CLINIC
- Practice address
- 1705 16TH Ave
Fulton, IL 61252-9708 - Phone
- (815) 589-2121
- Fax
- (815) 589-4468
- NPI assigned
- Apr 29, 2019
- Organization subpart
- No
Authorized official
- Name
- Mellissa Wood
- Title
- Coo/Cno
- Phone
- (563) 244-5608
Member of 2
Practitioners 3
-
Linda Marie Anders, DNP, MBA, APRN
-
Kimberly K Mulholland, ARNP
-
Ashley Ann Snyder, ARNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0430589 | Mercyone Fulton Family Medicine | Certificate of waiver | Apr 3, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1705 16TH Ave
Fulton, IL 61252-9708
Mailing address
621 S Illinois Ave Ste 103
Mason City, IA 50401-5489
Phone (641) 428-3900
Other names
- MercyOne Fulton Family Medicine
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All providers in Fulton, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.