Healthcare Provider Details

I. General information

NPI: 1780452227
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 KINGS ISLAND DR SUITE 120
MASON OH
45040
US

IV. Provider business mailing address

5470 KINGS ISLAND DR SUITE 120
MASON OH
45040
US

V. Phone/Fax

Practice location:
  • Phone: 513-347-9999
  • Fax: 513-874-3023
Mailing address:
  • Phone: 513-347-9999
  • Fax: 513-874-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CASSIE LOWE
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 513-952-5210