Healthcare Provider Details

I. General information

NPI: 1093103731
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS CINCINNATI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

IV. Provider business mailing address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-3494
  • Fax: 513-345-2606
Mailing address:
  • Phone: 513-421-3494
  • Fax: 513-345-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CASSIE HAVLIN
Title or Position: PAYER CREDENTIALING
Credential:
Phone: 513-981-4684