Provider Demographics
NPI:1376716357
Name:MERCY HEALTH - TIFFIN HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - TIFFIN HOSPITAL LLC
Other - Org Name:MERCY HOSPITAL OF TIFFIN, OHIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-307-0158
Mailing Address - Street 1:PO BOX 636535
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6535
Mailing Address - Country:US
Mailing Address - Phone:419-251-8997
Mailing Address - Fax:419-251-3553
Practice Address - Street 1:45 ST LAWRENCE DRIVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2611
Practice Address - Country:US
Practice Address - Phone:419-455-8505
Practice Address - Fax:419-455-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2692411Medicaid
OH2692411Medicaid