Provider Demographics
NPI:1942718713
Name:MERCY HEALTH-REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-REGIONAL MEDICAL CENTER LLC
Other - Org Name:MERCY HEALTH LORAIN OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:PO BOX 636409
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6409
Mailing Address - Country:US
Mailing Address - Phone:419-555-5555
Mailing Address - Fax:844-819-1196
Practice Address - Street 1:3600 KOLBE RD STE 102
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:419-555-5555
Practice Address - Fax:513-562-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336S0011X
OHPMY.022819500-03336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175303OtherPK