Healthcare Provider Details

I. General information

NPI: 1346244126
Provider Name (Legal Business Name): MERCY HEALTH-LOURDES HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

PO BOX 636545
CINCINNATI OH
45263-6545
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2163
  • Fax: 270-444-2460
Mailing address:
  • Phone: 270-444-2163
  • Fax: 270-444-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100304
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20A
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2489A
License Number StateKY

VIII. Authorized Official

Name: MR. MICHAEL YUNGMANN
Title or Position: CEO
Credential:
Phone: 270-444-2491