Provider Demographics
NPI:1790731016
Name:MERCY HEALTH - WILLARD HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - WILLARD HOSPITAL LLC
Other - Org Name:SISTERS OF MERCY OF WILLARD, OHIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BUFFY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DETTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-455-7074
Mailing Address - Street 1:PO BOX 636547
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6547
Mailing Address - Country:US
Mailing Address - Phone:419-964-5000
Mailing Address - Fax:419-964-5178
Practice Address - Street 1:1100 NEAL ZICK ROAD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9287
Practice Address - Country:US
Practice Address - Phone:419-964-5000
Practice Address - Fax:419-964-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000157361OtherANTHEM
OH9474500Medicaid
OH000000157361OtherANTHEM
OH9474500Medicaid
OH000000157361OtherANTHEM
OH9474500Medicaid