Provider Demographics
NPI:1386921948
Name:MERCY HEALTH CLINICS, LLC
Entity type:Organization
Organization Name:MERCY HEALTH CLINICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-779-0148
Mailing Address - Street 1:PO BOX 636493
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6493
Mailing Address - Country:US
Mailing Address - Phone:513-981-5098
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:749 IRVINE RD
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312-9732
Practice Address - Country:US
Practice Address - Phone:606-663-2153
Practice Address - Fax:606-663-7966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCUM & WALLACE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-10
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900249261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100233000Medicaid
KYP100016306Medicare PIN
KY7100233000Medicaid