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Organization
MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Active
Organization
MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Active
Other names
DBA Fredric Lax
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN SMITH (EXECUTIVE VICE PRESIDENT)
(419) 226-9052
Entity
Organization
Contact information
Practice address
770 W HIGH ST, SUITE 390, LIMA, OH 45801-3990
(419) 996-5202
Mailing address
PO BOX 73218, CLEVELAND, OH 44193-0002
(937) 291-7850
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
35067534
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359907
ANTHEM BLUE CROSS
ND
05
—
0995062
—
OH
01
—
118407446024
MEDICAL MUTUAL
OH
Enumeration date
04/28/2006
Last updated
01/13/2022
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