Healthcare Provider Details

I. General information

NPI: 1386921948
Provider Name (Legal Business Name): MERCY HEALTH CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 IRVINE RD
CLAY CITY KY
40312-9732
US

IV. Provider business mailing address

PO BOX 636493
CINCINNATI OH
45263-6493
US

V. Phone/Fax

Practice location:
  • Phone: 606-663-2153
  • Fax: 606-663-7966
Mailing address:
  • Phone: 513-981-5098
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900249
License Number StateKY

VIII. Authorized Official

Name: MS. TRENA LYNN STOCKER
Title or Position: PRESIDENT
Credential:
Phone: 859-779-0148