Provider Demographics
NPI:1104249051
Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-981-6292
Mailing Address - Street 1:4600 MCAULEY PL
Mailing Address - Street 2:ML 05047
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4733
Mailing Address - Country:US
Mailing Address - Phone:513-981-6643
Mailing Address - Fax:513-981-6192
Practice Address - Street 1:6350 GLENWAY AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6397
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-347-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6905520005Medicare NSC