1881917961 NPI number — MERRICARE MEDICAL SUPPLY LLC

Table of content: (NPI 1881917961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881917961 NPI number — MERRICARE MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRICARE MEDICAL SUPPLY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881917961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10387 WATER CREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46038-7419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-748-4032
Provider Business Mailing Address Fax Number:
317-770-8251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10387 WATER CREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038-7419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-748-4032
Provider Business Practice Location Address Fax Number:
317-770-8251
Provider Enumeration Date:
03/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NZEREM
Authorized Official First Name:
IFEYINWA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
COOWNER
Authorized Official Telephone Number:
317-748-4032

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)