Basic Information
| Provider Information | |||||||||
| NPI: | 1619903143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 JEFFERSON AVE | ||||||||
| Address2: | 4TH FL | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436241120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192518997 | ||||||||
| FaxNumber: | 4192513553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436241120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192511400 | ||||||||
| FaxNumber: | 4192511797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | PLATZKE | ||||||||
| AuthorizedOfficialFirstName: | SAMATHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4192512046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.