NPIMap

Organization Active NPI

Mercy Health System Corporation

Doing business as Mercy Mall LTC Pharmacy

  • Long Term Care Pharmacy
  • Janesville, WI
National Provider Identifier
1639460736
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
9068 Issued in WI
Legal business name
MERCY HEALTH SYSTEM CORPORATION
Doing business as
Mercy Mall LTC Pharmacy
Practice address
1010 N Washington St Ste 107
Janesville, WI 53548-1500
Phone
(608) 755-4196
Fax
(608) 755-8710
NPI assigned
Apr 22, 2011
Last updated
Oct 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joan Shadel
Title
Director of Retail Services
Phone
(608) 755-8787

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 9068 WI Primary

Addresses

Primary practice location

1010 N Washington St Ste 107
Janesville, WI 53548-1500

Mailing address

1010 N Washington St
Suite 107
Janesville, WI 53548-1500
Phone (608) 755-4196

Other identifiers 2

IdentifierTypeStateIssuer
1639460736MedicaidWI
5132597OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Mercy Mall LTC Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

1010 N Washington St
Ste 107
Janesville, WI 53548
Phone (608) 755-4196

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1639460736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N WASHINGTON ST",
            "address_2": "SUITE 107",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535481500",
            "telephone_number": "608-755-4196",
            "fax_number": "608-755-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N WASHINGTON ST STE 107",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535481500",
            "telephone_number": "608-755-4196",
            "fax_number": "608-755-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH SYSTEM CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-22",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "SHADEL",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "DIRECTOR OF RETAIL SERVICES",
        "authorized_official_telephone_number": "608-755-8787"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WI",
            "license": "9068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639460736",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5132597",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Mall LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.