1851726228 NPI number — MERIT HEALTHCARE INC.

Table of content: (NPI 1851726228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851726228 NPI number — MERIT HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIT HEALTHCARE 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:
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:
1851726228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 E TAHQUITZ CANYON WAY
Provider Second Line Business Mailing Address:
200-093
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-242-6561
Provider Business Mailing Address Fax Number:
760-242-1354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 E TAHQUITZ CANYON WAY
Provider Second Line Business Practice Location Address:
200-093
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-6784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-6561
Provider Business Practice Location Address Fax Number:
760-242-1354
Provider Enumeration Date:
09/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOZLOFF
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-242-6561

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C55616 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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