Provider Demographics
NPI:1720401086
Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS CINCINNATI LLC
Other - Org Name:
Other - Org Type:
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 1:10663 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4403
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-792-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6905520009Medicare NSC