Basic Information
| Provider Information | |||||||||
| NPI: | 1114699931 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631330 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886963541 | ||||||||
| FaxNumber: | 5139526002 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 MERCY HEALTH BLVD STE 450 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452111106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134510500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARDY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | SHANE | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5139525210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.