Healthcare Provider Details

I. General information

NPI: 1790281517
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 CINCINNATI DAYTON RD STE 110
LIBERTY TOWNSHIP OH
45044-9319
US

IV. Provider business mailing address

1701 MERCY HEALTH PL
CINCINNATI OH
45237-6147
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-6784
  • Fax: 513-981-8929
Mailing address:
  • Phone: 513-952-5210
  • Fax: 513-952-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ERIN FRIES
Title or Position: CMO, MEDICAL GROUP
Credential:
Phone: 513-952-5045