Provider Demographics
NPI:1992358766
Name:MERCY HEALTH PHYSICIANS - NORTH, LLC
Entity Type:Organization
Organization Name:MERCY HEALTH PHYSICIANS - NORTH, LLC
Other - Org Name:MERCY HEALTH - PERRYSBURG PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPCS
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-520-8637
Mailing Address - Street 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2272
Practice Address - Country:US
Practice Address - Phone:419-874-6888
Practice Address - Fax:419-848-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment