Provider Demographics
NPI:1063085421
Name:MERCY HEALTH PHYSICIANS KENTUCKY SPECIALTY CARE LLC
Entity type:Organization
Organization Name:MERCY HEALTH PHYSICIANS KENTUCKY SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-869-5016
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7907
Mailing Address - Country:US
Mailing Address - Phone:270-441-4510
Mailing Address - Fax:270-441-4512
Practice Address - Street 1:225 MEDICAL CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7907
Practice Address - Country:US
Practice Address - Phone:270-441-4510
Practice Address - Fax:270-441-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty