Healthcare Provider Details

I. General information

NPI: 1215994777
Provider Name (Legal Business Name): MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST SUITE 390
LIMA OH
45801-3990
US

IV. Provider business mailing address

PO BOX 73218
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5202
  • Fax:
Mailing address:
  • Phone: 937-291-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number35067534
License Number StateOH

VIII. Authorized Official

Name: MR. BRIAN SMITH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-226-9052