Provider Demographics
NPI:1598093825
Name:MERCY HEALTH - FAIRFIELD HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - FAIRFIELD HOSPITAL LLC
Other - Org Name:MERCY HOSPITAL FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-870-7111
Mailing Address - Street 1:PO BOX 635760
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5760
Mailing Address - Country:US
Mailing Address - Phone:513-870-7000
Mailing Address - Fax:513-981-6118
Practice Address - Street 1:3000 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5335
Practice Address - Country:US
Practice Address - Phone:513-870-7000
Practice Address - Fax:513-981-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36T-056273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5887278Medicaid