Provider Demographics
NPI:1629011234
Name:MERCY HEALTH - DEFIANCE HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - DEFIANCE HOSPITAL LLC
Other - Org Name:MERCY HEALTH - DEFIANCE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OFFICER DEFIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SELHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-785-3983
Mailing Address - Street 1:PO BOX 636524
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6524
Mailing Address - Country:US
Mailing Address - Phone:419-782-8444
Mailing Address - Fax:419-251-2109
Practice Address - Street 1:1404 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2440
Practice Address - Country:US
Practice Address - Phone:419-782-8444
Practice Address - Fax:419-251-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530309Medicaid
OH000000344458OtherANTHEM
OH000000344458OtherANTHEM
OH=========00OtherWORKERS COMPENSATION
OH360270Medicare ID - Type UnspecifiedMEDICARE
OH000000344458OtherANTHEM