Healthcare Provider Details

I. General information

NPI: 1942718713
Provider Name (Legal Business Name): MERCY HEALTH-REGIONAL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 102
LORAIN OH
44053-1652
US

IV. Provider business mailing address

PO BOX 636409
CINCINNATI OH
45263-6409
US

V. Phone/Fax

Practice location:
  • Phone: 419-555-5555
  • Fax: 440-960-4509
Mailing address:
  • Phone: 419-555-5555
  • Fax: 844-819-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPMY.022819500-0
License Number StateOH

VIII. Authorized Official

Name: KIMBERLY RALSTON
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 419-996-5119