Provider Demographics
NPI:1578551594
Name:MERCY SURGERY CENTER, LTD
Entity Type:Organization
Organization Name:MERCY SURGERY CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH (SALLY)
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA
Authorized Official - Phone:937-390-8310
Mailing Address - Street 1:2610 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1114
Mailing Address - Country:US
Mailing Address - Phone:937-390-8310
Mailing Address - Fax:937-390-8327
Practice Address - Street 1:2610 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1114
Practice Address - Country:US
Practice Address - Phone:937-390-8310
Practice Address - Fax:937-390-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH309-0388AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2033249Medicaid
OH3610831Medicare PIN