Provider Demographics
NPI:1346207404
Name:COMMUNITY MERCY HEALTH PARTNERS
Entity Type:Organization
Organization Name:COMMUNITY MERCY HEALTH PARTNERS
Other - Org Name:EXCEL SPORTS MEDICINE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-523-5500
Mailing Address - Street 1:2600 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1114
Mailing Address - Country:US
Mailing Address - Phone:937-390-5075
Mailing Address - Fax:
Practice Address - Street 1:2600 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1114
Practice Address - Country:US
Practice Address - Phone:937-390-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5887634RMedicaid
OH360086Medicare Oscar/Certification