Provider Demographics
NPI:1841241270
Name:MERCY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER, INC.
Other - Org Name:MERCY MEDICAL CENTER HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:330-489-1131
Mailing Address - Street 1:1320 MERCY DR NW
Mailing Address - Street 2:
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:
Practice Address - Street 1:7568 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-6922
Practice Address - Country:US
Practice Address - Phone:330-492-8803
Practice Address - Fax:330-966-8099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0298771Medicaid
OH36-7256Medicare ID - Type Unspecified