Provider Demographics
NPI:1154851178
Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Other - Org Name:MERCY HEALTH - BE WELL WITHIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-952-5210
Mailing Address - Street 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:513-952-5930
Mailing Address - Fax:513-952-5931
Practice Address - Street 1:1701 MERCY HEALTH PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6147
Practice Address - Country:US
Practice Address - Phone:513-952-5930
Practice Address - Fax:513-952-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270942Medicaid