Provider Demographics
NPI:1184020067
Name:MERCY HEALTH PHYSICIANS CINCINNATI, LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-981-6610
Mailing Address - Street 1:PO BOX 632110
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2110
Mailing Address - Country:US
Mailing Address - Phone:513-981-6610
Mailing Address - Fax:513-981-6103
Practice Address - Street 1:2859 BOUDINOT AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-1606
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-981-4346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH WESTERN HILLS ORTHO & SPINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270942Medicaid
OH0270942Medicaid