Healthcare Provider Details

I. General information

NPI: 1316967904
Provider Name (Legal Business Name): MERCER OSTEOPATHIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 UNION CITY ROAD
FORT RECOVERY OH
45846-0635
US

IV. Provider business mailing address

1830 UNION CITY RD
FT RECOVERY OH
45846-0635
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-4144
  • Fax: 419-375-4361
Mailing address:
  • Phone: 419-375-4144
  • Fax: 419-375-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34 004555
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 05008
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34 005329
License Number StateOH

VIII. Authorized Official

Name: DR. EDWARD E HOSBACH
Title or Position: PRESIDENT
Credential: DO
Phone: 419-375-4144