Provider Demographics
NPI:1396143814
Name:MERCY HEALTH PHYSICIANS-NORTH LLC
Entity type:Organization
Organization Name:MERCY HEALTH PHYSICIANS-NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DACRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-9650
Mailing Address - Street 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 W SYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4100
Practice Address - Country:US
Practice Address - Phone:419-474-3338
Practice Address - Fax:419-474-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939806Medicaid
OH9382361Medicare PIN