1346616000 NPI number — MERCHANT HEALTH SYSTEMS, INC.

Table of content: (NPI 1346616000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346616000 NPI number — MERCHANT HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCHANT HEALTH SYSTEMS, INC.
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:
AFFINITY HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1346616000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 WISTERIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27523-7303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-604-7281
Provider Business Mailing Address Fax Number:
919-303-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1342 N BRIGHTLEAF BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-7388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-604-7281
Provider Business Practice Location Address Fax Number:
919-303-6006
Provider Enumeration Date:
08/18/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHERALI
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
919-604-7281

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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