Provider Demographics
NPI:1700053576
Name:CLEVELAND CLINIC MERCY HOSPITAL
Entity Type:Organization
Organization Name:CLEVELAND CLINIC MERCY HOSPITAL
Other - Org Name:MERCY DENTAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-489-1268
Mailing Address - Street 1:1320 MERCY DR NW
Mailing Address - Street 2:2ND FLOOR - SURGERY CENTER
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2614
Mailing Address - Country:US
Mailing Address - Phone:330-489-1000
Mailing Address - Fax:330-471-5947
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:2ND FLOOR - SURGERY CENTER
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1000
Practice Address - Fax:330-471-5947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2690039Medicaid