Provider Demographics
NPI:1457568420
Name:MERCY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MERCY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CAROZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-851-1144
Mailing Address - Street 1:900 SCIOTO ST
Mailing Address - Street 2:MERCY MEDICAL BUILDING SUITE 1
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2251
Mailing Address - Country:US
Mailing Address - Phone:937-484-6784
Mailing Address - Fax:937-484-6531
Practice Address - Street 1:900 SCIOTO ST
Practice Address - Street 2:MERCY MEDICAL BUILDING SUITE 1
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2251
Practice Address - Country:US
Practice Address - Phone:937-484-6784
Practice Address - Fax:937-484-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3080455Medicaid
OHP00919596OtherMEDICARE RR
OHP00919596OtherMEDICARE RR