Healthcare Provider Details

I. General information

NPI: 1013210244
Provider Name (Legal Business Name): MERCY HEALTH - ANDERSON HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE ROAD
CINCINNATI OH
45255
US

IV. Provider business mailing address

PO BOX 639922
CINCINNATI OH
45263-9922
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-4669
  • Fax: 513-624-4820
Mailing address:
  • Phone: 513-624-4669
  • Fax: 513-624-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number021992150
License Number StateOH

VIII. Authorized Official

Name: KIMBERLY M RALSTON
Title or Position: DIRECTOR REIMBURSEMENT
Credential:
Phone: 419-996-5119