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General NPI Number Information
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NPI Number | 1194919324
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Entity Type | Organization
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Legal Business Name | MERCY MEDICAL PARTNERS NORTHERN REIGON LLC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 1400 E 2ND ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2440
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Country | US
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Telephone | 419-784-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 JEFFERSON AVE FL 4
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City | TOLEDO
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State | OH
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Zip | 43604-7102
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Country | US
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Telephone | 419-251-8983
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Fax | 419-251-6719
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Authorized Official
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Title or Position | VICE PRESIDENT/ADMINISTRATOR
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Name | MICHELE MONTAGUE
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Credential |
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Telephone | 419-251-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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