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NPI Code Detail

MEDICARE: MERCY HEALTH BOARDMAN SURGERY

MEDICARE: MERCY HEALTH BOARDMAN SURGERY
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1700492170
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY HEALTH BOARDMAN SURGERY
Provider Business Mailing Address
First Line : 4147 WESTFORD PL
Second Line :
City : CANFIELD
State : OH
Zip : 44406-8086
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4147 WESTFORD PL
Second Line :
City : CANFIELD
State : OH
Zip : 44406-8086
Country : US
Telephone Number : 513-952-5273
Fax Number :
Authorized Official
Title or Position : SYSTEM DIRECTOR PAYOR ADMIN
Name : MRS. KIMBERLY RALSTON
Credential :
Telephone Number : 419-996-5119
Provider Enumeration Date : 09/21/2020
Last Update Date : 09/21/2020

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Directions to “MERCY HEALTH BOARDMAN SURGERY ” Practice Location

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