Provider Demographics
NPI:1851339832
Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Other - Org Name:MERCY HEALTH-HOME INFUSION, LIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO & VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-226-9775
Mailing Address - Street 1:959 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2457
Mailing Address - Country:US
Mailing Address - Phone:419-226-9597
Mailing Address - Fax:419-226-4363
Practice Address - Street 1:959 W NORTH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-226-9597
Practice Address - Fax:419-226-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0004X
OH0227770503336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176530OtherPK
OH2062280Medicaid