Provider Demographics
NPI:1730724147
Name:MERCY HEALTH PHYSICIANS, LORAIN, LLC
Entity type:Organization
Organization Name:MERCY HEALTH PHYSICIANS, LORAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGION CEO & SVP LOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-960-3295
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:888-696-3541
Mailing Address - Fax:513-981-4477
Practice Address - Street 1:224 W LORAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1096
Practice Address - Country:US
Practice Address - Phone:440-222-4970
Practice Address - Fax:440-222-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies