Provider Demographics
NPI:1467493551
Name:MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Other - Org Name:MERCY HEALTH ST VINCENT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT ST VINCENT MEDICAL CENTER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-3592
Mailing Address - Street 1:PO BOX 636447
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6447
Mailing Address - Country:US
Mailing Address - Phone:419-251-3232
Mailing Address - Fax:419-251-3810
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:419-251-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
OH4840333416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAN0038OtherSELECT CARE
MI00799AOtherHEALTH ALLIANCE PLAN
MI5172616OtherMEDICAID
OH000000189063OtherANTHEM
MI1017010001Medicaid
OH600563OtherBUCKEYE
OH7649905Medicaid
OH05001OtherPARAMOUNT
MI00338OtherMICHIGAN BLUE CROSS
OH7649905Medicaid
OH=========01OtherOCCUPATIONAL HEALTH
OH360112Medicare ID - Type UnspecifiedMEDICARE
MIAN0038OtherSELECT CARE
MI00799AOtherHEALTH ALLIANCE PLAN
OH7649905Medicaid