1033213616 NPI number — MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC

Table of content: (NPI 1033213616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033213616 NPI number — MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARNESS HEALTH PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033213616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639922
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-9922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-251-2485
Provider Business Mailing Address Fax Number:
419-251-2394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2213 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43620-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-251-2485
Provider Business Practice Location Address Fax Number:
419-251-2394
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RALSTON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
SYSTEM DIRECTOR
Authorized Official Telephone Number:
419-996-5119

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: RTP020499950 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0655367 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2077109 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com