Provider Demographics
NPI:1932166071
Name:COMMUNITY MERCY HEALTH PARTNERS
Entity Type:Organization
Organization Name:COMMUNITY MERCY HEALTH PARTNERS
Other - Org Name:MERCY WELL CHILD PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-523-5501
Mailing Address - Street 1:904 SCIOTO STREET
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2226
Mailing Address - Country:US
Mailing Address - Phone:937-484-6157
Mailing Address - Fax:
Practice Address - Street 1:904 SCIOTO STREET
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2226
Practice Address - Country:US
Practice Address - Phone:937-484-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3090793Medicaid
OH0920169Medicaid