Provider Demographics
NPI:1558849612
Name:MERCY HEALTH PHYSICIANS YOUNGSTOWN LLC
Entity type:Organization
Organization Name:MERCY HEALTH PHYSICIANS YOUNGSTOWN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGION CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-884-7010
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 1:564 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:234-567-8150
Practice Address - Fax:234-567-8189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH PHYSICIANS YOUNGSTOWN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3136878Medicaid