Healthcare Provider Details

I. General information

NPI: 1659722171
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

250 E FEDERAL ST
YOUNGSTOWN OH
44503-1814
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE WALKER
Title or Position: REVENUE CYCLE LIAISON
Credential:
Phone: 330-301-0406