MEDICARE: MERCY HEALTH-ST CHARLES HOSPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician
3	367A00000X	Advanced Practice Midwife
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1386689933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH-ST CHARLES HOSPITAL LLC

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	4TH FL
City	:	TOLEDO
State	:	OH
Zip	:	43624-1120
Country	:	US
Telephone Number	:	419-251-8997
Fax Number	:	419-251-3553

Provider Business Practice Location Address
First Line	:	1020 VARLAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43605-3245
Country	:	US
Telephone Number	:	419-696-1520
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SAMANTHA PLATZKE
Credential	:
Telephone Number	:	419-251-2046

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/13/2022

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