Provider Demographics
NPI:1487037156
Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Other - Org Name:MERCY HEALTH - PAIN MEDICINE, WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CURNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-981-4444
Mailing Address - Street 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:445
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-981-4444
Mailing Address - Fax:513-853-4095
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:445
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1105
Practice Address - Country:US
Practice Address - Phone:513-981-4444
Practice Address - Fax:513-853-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270942Medicaid
OH0270942Medicaid