Healthcare Provider Details

I. General information

NPI: 1457321093
Provider Name (Legal Business Name): MERCY HEALTH-LOURDES HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR STE 203
PADUCAH KY
42003-7907
US

IV. Provider business mailing address

225 MEDICAL CENTER DR STE 203
PADUCAH KY
42003-7907
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-3636
  • Fax:
Mailing address:
  • Phone: 270-415-3636
  • Fax: 270-444-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number400009
License Number StateKY

VIII. Authorized Official

Name: KIMBERLY RALSTON
Title or Position: SYSTEM DIRECTOR PAYOR ADMIN
Credential:
Phone: 419-996-5119