Healthcare Provider Details

I. General information

NPI: 1437980174
Provider Name (Legal Business Name): BON SECOURS MERCY HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE 350
LIMA OH
45801-5901
US

IV. Provider business mailing address

206 HALL AVE
COLUMBUS GROVE OH
45830-1315
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-8950
  • Fax:
Mailing address:
  • Phone: 419-234-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LOGAN JAMES RIDENOUR
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 419-234-7449