1629094115 NPI number — MERCY HEALTH-ST RITAS MEDICAL CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629094115 NPI number — MERCY HEALTH-ST RITAS MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH-ST RITAS 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:
MH-HOME MEDICAL EQUIPMENT, LIMA
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:
1629094115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636372
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:
45263-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-226-9581
Provider Business Mailing Address Fax Number:
419-226-9847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-226-9581
Provider Business Practice Location Address Fax Number:
419-226-9847
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIEGER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL CFO & VP OF FINANCE
Authorized Official Telephone Number:
419-226-9775

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  020861750 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 02-049178 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 02-0861750 , 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: 0559202 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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