Provider Demographics
NPI:1992705669
Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-996-5089
Mailing Address - Street 1:830 W HIGH ST
Mailing Address - Street 2:STE. 208
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3971
Mailing Address - Country:US
Mailing Address - Phone:419-996-5089
Mailing Address - Fax:419-996-5295
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:STE. 208
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-996-5089
Practice Address - Fax:419-996-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004184207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2534449Medicaid
OH9350481Medicare ID - Type Unspecified