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General NPI Number Information
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NPI Number | 1700492170
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH BOARDMAN SURGERY
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 4147 WESTFORD PL
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City | CANFIELD
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State | OH
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Zip | 44406-8086
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Country | US
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Telephone | 513-952-5273
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Fax |
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Provider Business Mailing Address
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Address Line | 4147 WESTFORD PL
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City | CANFIELD
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State | OH
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Zip | 44406-8086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SYSTEM DIRECTOR PAYOR ADMIN
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Name | MRS. KIMBERLY RALSTON
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Credential |
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Telephone | 419-996-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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