Provider Demographics
NPI:1417629098
Name:MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
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:513-554-8080
Mailing Address - Street 1:PO BOX 631330
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1330
Mailing Address - Country:US
Mailing Address - Phone:888-696-3541
Mailing Address - Fax:513-952-6002
Practice Address - Street 1:4701 CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8330
Practice Address - Country:US
Practice Address - Phone:513-554-8080
Practice Address - Fax:513-554-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies