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

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0430589Mercyone Fulton Family Medicine
1705 16TH Av, Fulton, IL 61252
Certificate of waiverApr 3, 2027

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
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 Doing business as

Other providers in Fulton, IL

All providers in Fulton, IL · Family Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.