MEDICARE: MERCY HEALTH-ST RITAS MEDICAL CENTER 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881869899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH-ST RITAS MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 951999
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0021
Country	:	US
Telephone Number	:	419-996-5114
Fax Number	:	419-996-5410

Provider Business Practice Location Address
First Line	:	1800 E 5TH ST
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9180
Country	:	US
Telephone Number	:	419-996-5030
Fax Number	:	419-996-5458

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	01/13/2022

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