Healthcare Provider Details

I. General information

NPI: 1407518749
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS YOUNGSTOWN SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 E 2ND ST
SALEM OH
44460-2914
US

IV. Provider business mailing address

PO BOX 631332
CINCINNATI OH
45263-1332
US

V. Phone/Fax

Practice location:
  • Phone: 234-567-8150
  • Fax:
Mailing address:
  • Phone: 888-696-3541
  • Fax: 513-952-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: WILBUR GAY
Title or Position: CFO
Credential:
Phone: 888-696-3541