Provider Demographics
NPI:1700806023
Name:RIVERSIDE MERCY HOSPITAL
Entity Type:Organization
Organization Name:RIVERSIDE MERCY HOSPITAL
Other - Org Name:ST ANNE MERCY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMATHA
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 1:3404 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4467
Practice Address - Country:US
Practice Address - Phone:419-407-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ANNE MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2805067Medicaid
OH2805067Medicaid
OHRI3602621Medicare PIN