Provider Demographics
NPI:1215932637
Name:MERCY HEALTH - CLERMONT HOSPITAL LLC
Entity type:Organization
Organization Name:MERCY HEALTH - CLERMONT HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEBENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-981-4504
Mailing Address - Street 1:4370 GLENDALE MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3706
Mailing Address - Country:US
Mailing Address - Phone:513-981-4504
Mailing Address - Fax:513-981-4597
Practice Address - Street 1:4370 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3706
Practice Address - Country:US
Practice Address - Phone:513-981-4504
Practice Address - Fax:513-981-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHIO DOESN'T REQUIRE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0960965OtherBUCKEYE COMMUNITY HEALTH
OH0960965Medicaid
OH000000003146OtherANTHEM
OH=========OtherCHANDLER GROUP (PHS / DCA
OH=========OtherAETNA
OH=========OtherACM (UHC)
OH=========OtherEMERALD HEALTH
OH=========OtherPHCS
OH367236Medicare ID - Type Unspecified