Basic Information
| Provider Information | |||||||||
| NPI: | 1376716357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HEALTH - TIFFIN HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | MERCY HOSPITAL OF TIFFIN, OHIO | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636535 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192518997 | ||||||||
| FaxNumber: | 4192513553 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 ST LAWRENCE DRIVE | ||||||||
| Address2: | |||||||||
| City: | TIFFIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448832611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194558505 | ||||||||
| FaxNumber: | 4194558504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARBEE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4193070158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2692411 | 05 | OH | MEDICAID |