Provider Demographics
NPI:1982802971
Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Other - Org Name:DR. MICHAEL MARTZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-227-3361
Mailing Address - Street 1:PO BOX 73471
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:419-224-1234
Mailing Address - Fax:419-226-9831
Practice Address - Street 1:825 S CABLE RD UNIT A
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3467
Practice Address - Country:US
Practice Address - Phone:419-224-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. RITA'S MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-58001642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2677965Medicaid
OHI61395Medicare UPIN
OH2677965Medicaid