Healthcare Provider Details

I. General information

NPI: 1316975170
Provider Name (Legal Business Name): MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHERRY ST SUITE 2300
TOLEDO OH
43608-2673
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 419-251-8030
  • Fax:
Mailing address:
  • Phone: 419-251-8997
  • Fax: 419-251-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State

VIII. Authorized Official

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