Provider Demographics
NPI:1285632109
Name:MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-779-0148
Mailing Address - Street 1:60 MERCY CT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1331
Mailing Address - Country:US
Mailing Address - Phone:606-723-2115
Mailing Address - Fax:606-723-2951
Practice Address - Street 1:60 MERCY CT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1331
Practice Address - Country:US
Practice Address - Phone:606-723-2115
Practice Address - Fax:606-723-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01002526Medicaid
KY01002526Medicaid