=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538619820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY HEALTH - CLERMONT HOSPITAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2016
-----------------------------------------------------
Last Update Date | 04/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 HOSPITAL DR STE 100
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-8517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 HOSPITAL DR STE 100
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-732-8517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SYSTEM DIRECTOR
-----------------------------------------------------
Name | KIMBERLY RALSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-996-5119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 022633450
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------