Provider Demographics
NPI:1568562551
Name:MERCY HEALTH - CLERMONT HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - CLERMONT HOSPITAL LLC
Other - Org Name:CLERMONT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MERCY HEALTH CLERMONT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-732-8252
Mailing Address - Street 1:PO BOX 635804
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5804
Mailing Address - Country:US
Mailing Address - Phone:513-732-8200
Mailing Address - Fax:513-732-8537
Practice Address - Street 1:3000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1921
Practice Address - Country:US
Practice Address - Phone:513-732-8200
Practice Address - Fax:513-732-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217447Medicaid
OH1028OtherOHIO DEPT OF HEALTH
OH1028OtherOHIO DEPT OF HEALTH