Provider Demographics
NPI:1417992710
Name:M E D F PHYSICIANS CORPORATION
Entity Type:Organization
Organization Name:M E D F PHYSICIANS CORPORATION
Other - Org Name:MERCER HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-678-5117
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1613
Mailing Address - Country:US
Mailing Address - Phone:419-678-2341
Mailing Address - Fax:
Practice Address - Street 1:830 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1657
Practice Address - Country:US
Practice Address - Phone:567-890-7185
Practice Address - Fax:419-586-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330196Medicaid
OH9319511Medicare PIN
OH9319514Medicare PIN