Provider Demographics
NPI:1497792568
Name:MERCY HEALTH-ST CHARLES HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ST CHARLES HOSPITAL LLC
Other - Org Name:ST CHARLES HOSPITAL OF OREGON, OHIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDEN & COO ST CHARLES
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-696-7692
Mailing Address - Street 1:PO BOX 636422
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6422
Mailing Address - Country:US
Mailing Address - Phone:419-696-7200
Mailing Address - Fax:419-696-6886
Practice Address - Street 1:2600 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3207
Practice Address - Country:US
Practice Address - Phone:419-696-7200
Practice Address - Fax:419-696-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7644259Medicaid
OH00000064557OtherANTHEM
OH601117OtherBUCKEYE
OH05003OtherPARAMOUNT
MA405172581Medicaid
MI07508OtherBLUE CARE NETWORK HMO
OH00000064557OtherANTHEM
OH05003OtherPARAMOUNT
OH=========OtherCOMMERCIAL
MA405172581Medicaid
MI07508OtherBLUE CARE NETWORK HMO