Provider Demographics
NPI:1609151471
Name:MERCY HEALTH CLINICS, LLC
Entity Type:Organization
Organization Name:MERCY HEALTH CLINICS, LLC
Other - Org Name:MERCY MEDICAL CLINIC OF LEE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-779-0148
Mailing Address - Street 1:PO BOX 636493
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6493
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1025 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-0000
Practice Address - Country:US
Practice Address - Phone:606-464-8806
Practice Address - Fax:606-464-9453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCUM AND WALLACE MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-12
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100244280Medicaid
KY7100244280Medicaid
KYP100016306Medicare PIN
KYP100016306Medicare PIN