Healthcare Provider Details

I. General information

NPI: 1053706903
Provider Name (Legal Business Name): MERCY HEALTH - ST ANNE HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 REGENCY CT SUITE 101
TOLEDO OH
43623-3090
US

IV. Provider business mailing address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-0003
  • Fax:
Mailing address:
  • Phone: 419-407-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY BERTKE
Title or Position: CEO
Credential:
Phone: 419-407-2400