Healthcare Provider Details

I. General information

NPI: 1760649925
Provider Name (Legal Business Name): MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR SUITE 4
DUNDEE MI
48131-8644
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-2673
  • Fax:
Mailing address:
  • Phone: 419-251-2673
  • Fax: 419-251-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA PLAZKE
Title or Position: CFO- SENIOR VP
Credential:
Phone: 419-251-2673