Healthcare Provider Details

I. General information

NPI: 1790731016
Provider Name (Legal Business Name): MERCY HEALTH - WILLARD HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEAL ZICK ROAD
WILLARD OH
44890-9287
US

IV. Provider business mailing address

PO BOX 636547
CINCINNATI OH
45263-6547
US

V. Phone/Fax

Practice location:
  • Phone: 419-964-5000
  • Fax: 419-964-5178
Mailing address:
  • Phone: 419-964-5000
  • Fax: 419-964-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. BUFFY LYNN DETTERMAN
Title or Position: CEO
Credential:
Phone: 419-455-7074