1861641417 NPI number — MERCY HEALTH SYSTEM-NORTHERN REGION

Table of content: (NPI 1861641417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861641417 NPI number — MERCY HEALTH SYSTEM-NORTHERN REGION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH SYSTEM-NORTHERN REGION
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:
MERCY HEALTH PARTNERS
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:
1861641417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 JEFFERSON AVE
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-251-2673
Provider Business Mailing Address Fax Number:
419-251-0916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 S CONWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-935-0187
Provider Business Practice Location Address Fax Number:
419-935-0200
Provider Enumeration Date:
09/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PLATZKE
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
419-251-0705

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com