| Mercyland Psychiatry | |
|
530 W Main St Sun Prairie WI 53590-3219 | |
| (802) 399-9114 | |
| (608) 318-2789 |
| Full Name | Mercyland Psychiatry |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 530 W Main St, Sun Prairie, Wisconsin |
| Authorized Official Name and Position | Adebowale Mofikoya (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8023999114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercyland Psychiatry 530 W Main St Sun Prairie WI 53590-3219 Ph: (802) 399-9114 | Mercyland Psychiatry 530 W Main St Sun Prairie WI 53590-3219 Ph: (802) 399-9114 |
| NPI Number | 1194228114 |
|---|---|
| Provider Enumeration Date | 03/15/2018 |
| Last Update Date | 05/07/2018 |
| Medicare PECOS PAC ID | 3274897897 |
|---|---|
| Medicare Enrollment ID | O20180508001446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194228114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 60574-20 (Wisconsin) | Primary |
| Provider Name | Adebowale Mofikoya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275794422 PECOS PAC ID: 0143477166 Enrollment ID: I20130726000394 |
| Provider Name | Jean Ann Trost |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962164798 PECOS PAC ID: 8022408475 Enrollment ID: I20211130000068 |
| Provider Name | Fauzia Nimako Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851176283 PECOS PAC ID: 1254772981 Enrollment ID: I20240513003403 |
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