Provider Demographics
NPI:1639503477
Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Other - Org Name:MERCY HEALTH WELLINGTON ORTHOPAEDICS, WEST CHESTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO, MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-952-5045
Mailing Address - Street 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8737 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4878
Practice Address - Country:US
Practice Address - Phone:513-645-2220
Practice Address - Fax:513-645-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270942Medicaid
OH6905520004Medicare NSC