Provider Demographics
NPI:1598465494
Name:MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-605-3762
Mailing Address - Street 1:201 OLD BANK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2443
Mailing Address - Country:US
Mailing Address - Phone:513-248-0100
Mailing Address - Fax:513-248-4334
Practice Address - Street 1:201 OLD BANK RD STE 103
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2443
Practice Address - Country:US
Practice Address - Phone:513-248-0100
Practice Address - Fax:513-248-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies