NPIMap

Organization Active NPI

Mercy Health-Marcum & Wallace Hospital LLC

  • Surgery Physician
  • Irvine, KY
National Provider Identifier
1770734691
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC
Practice address
60 Mercy CT
Irvine, KY 40336-1331
Phone
(606) 723-2115
Fax
(606) 723-2951
NPI assigned
Oct 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Trena Lynn Stocker
Title
President
Phone
(859) 779-0148

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X KY Primary

Addresses

Primary practice location

60 Mercy CT
Irvine, KY 40336-1331

Mailing address

PO Box 636544
Cincinnati, OH 45263-6544
Phone (606) 723-2115

Other names 1

  • Marcum & Wallace Memorial Hospital, Inc. Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other BLUEMARK

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

115 Main St
Irvine, KY 40336
Phone (606) 723-0122

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1770734691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636544",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636544",
            "telephone_number": "606-723-2115",
            "fax_number": "606-723-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MERCY CT",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "403361331",
            "telephone_number": "606-723-2115",
            "fax_number": "606-723-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "STOCKER",
        "authorized_official_first_name": "TRENA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-779-0148",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "BLUEMARK",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Marcum & Wallace Memorial Hospital, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Marcum & Wallace Memorial Hospital, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Irvine, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.