Provider Demographics
NPI:1912954553
Name:MERCY HEALTH - ST ANNE HOSPITAL LLC
Entity type:Organization
Organization Name:MERCY HEALTH - ST ANNE HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-407-2400
Mailing Address - Street 1:PO BOX 636512
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6512
Mailing Address - Country:US
Mailing Address - Phone:419-407-2400
Mailing Address - Fax:419-407-3888
Practice Address - Street 1:3404 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4467
Practice Address - Country:US
Practice Address - Phone:419-407-2400
Practice Address - Fax:419-407-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05001OtherPARAMOUNT ADVANTAGE
OH2037085Medicaid
MI5172616Medicaid
OH04157OtherPARAMOUNT
OH000000156916OtherANTHEM
MI5172616Medicaid
OH000000156916OtherANTHEM
OH04157OtherPARAMOUNT
OH360262Medicare ID - Type UnspecifiedMEDICARE