Provider Demographics
NPI:1679518724
Name:NWO INTEGRATED LABORATORIES MERCY LLC
Entity Type:Organization
Organization Name:NWO INTEGRATED LABORATORIES MERCY LLC
Other - Org Name:MERCY INTEGRATED LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-8944
Mailing Address - Street 1:2222 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2673
Mailing Address - Country:US
Mailing Address - Phone:419-251-8600
Mailing Address - Fax:
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7649905Medicaid
OH690008893OtherRR MEDICARE
MI5172616Medicaid
OH000000189063OtherANTHEM
MI1017010001OtherWELLNESS PLAN
OH7649905Medicaid
OH7649905Medicaid