Healthcare Provider Details

I. General information

NPI: 1205384161
Provider Name (Legal Business Name): MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
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 636372
CINCINNATI OH
45263-6372
US

V. Phone/Fax

Practice location:
  • Phone: 419-995-4949
  • Fax: 419-996-4979
Mailing address:
  • Phone: 419-995-4949
  • Fax: 419-996-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRTP.022641200-0
License Number StateOH

VII. Legacy identifiers

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

# 1
Identifier2164174
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: TIM RIEGER
Title or Position: SYSTEM DIRECTOR, RETAIL PHARMACY
Credential:
Phone: 419-226-9775