Healthcare Provider Details

I. General information

NPI: 1770703910
Provider Name (Legal Business Name): MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

PO BOX 931325
CLEVELAND OH
44193-1517
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-9585
  • Fax:
Mailing address:
  • Phone: 419-996-5114
  • Fax: 419-226-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0809450
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: BRIAN SMITH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-996-5119