MEDICARE: MERCY HEALTH-LOURDES HOSPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	400009	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457321093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH-LOURDES HOSPITAL LLC

Provider Business Mailing Address
First Line	:	225 MEDICAL CENTER DR STE 203
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-7907
Country	:	US
Telephone Number	:	270-415-3636
Fax Number	:	270-444-2379

Provider Business Practice Location Address
First Line	:	225 MEDICAL CENTER DR STE 203
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-7907
Country	:	US
Telephone Number	:	270-415-3636
Fax Number	:

Authorized Official
Title or Position	:	SYSTEM DIRECTOR PAYOR ADMIN
Name	:	KIMBERLY RALSTON
Credential	:
Telephone Number	:	419-996-5119

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	12/12/2022

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