1457497307 NPI number — FAROUK E MERCHO MD

Table of content: FAROUK E MERCHO MD (NPI 1457497307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457497307 NPI number — FAROUK E MERCHO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCHO
Provider First Name:
FAROUK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERCHO
Provider Other First Name:
FRANK
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457497307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 ST FRANCIS WAY
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47905-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-446-4819
Provider Business Mailing Address Fax Number:
765-446-4859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S CREASY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-4972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-446-4819
Provider Business Practice Location Address Fax Number:
765-446-4859
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  01031856A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 35.088403 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000379915 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00817909 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000653260 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100320650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2863414 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101832200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com