MEDICARE: MERCY HEALTH - CLERMONT HOSPITAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	022633450	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2164553	OTHER		PK

General Provider Information

NPI Number	:	1538619820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH - CLERMONT HOSPITAL LLC

Provider Business Mailing Address
First Line	:	2055 HOSPITAL DR STE 100
Second Line	:
City	:	BATAVIA
State	:	OH
Zip	:	45103-1964
Country	:	US
Telephone Number	:	513-732-8517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 HOSPITAL DR STE 100
Second Line	:
City	:	BATAVIA
State	:	OH
Zip	:	45103-1964
Country	:	US
Telephone Number	:	513-732-8517
Fax Number	:

Authorized Official
Title or Position	:	SYSTEM DIRECTOR
Name	:	KIMBERLY RALSTON
Credential	:
Telephone Number	:	419-996-5119

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	04/21/2023

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