Provider Demographics
NPI:1639114325
Name:MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC
Other - Org Name:NAVARRE FAMILY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-2046
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43697-1079
Mailing Address - Country:US
Mailing Address - Phone:419-251-8997
Mailing Address - Fax:419-251-3553
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-696-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA1982Medicare PIN
OHST9308636Medicare PIN