1649301557 NPI number — MERCY HEALTH YOUNGSTOWN 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 1649301557 NPI number — MERCY HEALTH YOUNGSTOWN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH YOUNGSTOWN 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:
Provider Other Organization Name Type Code:
6
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:
1649301557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2022
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:
330-480-3804
Provider Business Mailing Address Fax Number:
330-480-3012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 BELMONT AVE
Provider Second Line Business Practice Location Address:
PARK AVE LOBBY
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44504-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-480-3804
Provider Business Practice Location Address Fax Number:
330-480-3012
Provider Enumeration Date:
03/09/2007

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: 021423800 , 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: 2079721 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2475049 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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