Healthcare Provider Details

I. General information

NPI: 1639105208
Provider Name (Legal Business Name): RIVERSIDE MERCY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 TALMADGE RD SUITE 200
TOLEDO OH
43623-2167
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FL
TOLEDO OH
43624-1120
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-3990
  • Fax:
Mailing address:
  • Phone: 419-251-8997
  • Fax: 419-251-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA PLATZKE
Title or Position: CFO
Credential:
Phone: 419-251-2046