Provider Demographics
NPI:1942245154
Name:MERCY HEALTH-ST CHARLES HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ST CHARLES HOSPITAL LLC
Other - Org Name:BAY MEADOWS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-2046
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FL
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43624-1120
Mailing Address - Country:US
Mailing Address - Phone:419-251-8997
Mailing Address - Fax:419-251-3553
Practice Address - Street 1:2815 DUSTIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3495
Practice Address - Country:US
Practice Address - Phone:419-874-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHST9935206Medicare PIN
OHC30118Medicare PIN