Healthcare Provider Details

I. General information

NPI: 1255009601
Provider Name (Legal Business Name): MERCY HEALTH PHYSICIANS YOUNGSTOWN SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 NILES CORTLAND RD NE
WARREN OH
44484-1055
US

IV. Provider business mailing address

1932 NILES CORTLAND RD NE
WARREN OH
44484-1055
US

V. Phone/Fax

Practice location:
  • Phone: 330-306-5300
  • Fax:
Mailing address:
  • Phone: 330-306-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILBUR GAY
Title or Position: CFO, MEDICAL GROUP
Credential:
Phone: 864-255-1904