Provider Demographics
NPI:1083163729
Name:MERCY HEALTH REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH REGIONAL MEDICAL CENTER LLC
Other - Org Name:MERCY HEALTH REGIONAL MEDICAL CENTER CLIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-960-3295
Mailing Address - Street 1:3700 KOLBE RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1611
Mailing Address - Country:US
Mailing Address - Phone:440-960-4740
Mailing Address - Fax:
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory