Healthcare Provider Details

I. General information

NPI: 1144495151
Provider Name (Legal Business Name): MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 ALLENTOWN RD
LIMA OH
45805-1705
US

IV. Provider business mailing address

PO BOX 951999
CLEVELAND OH
44193-0021
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-2245
  • Fax: 419-229-1573
Mailing address:
  • Phone: 419-996-5114
  • Fax: 419-996-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7649503
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MR. BRIAN SMITH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-226-9502