1164694345 NPI number — CARMEN MERRIWEATHER MEDICAL ASSISTANT

Table of content: CARMEN MERRIWEATHER MEDICAL ASSISTANT (NPI 1164694345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164694345 NPI number — CARMEN MERRIWEATHER MEDICAL ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRIWEATHER
Provider First Name:
CARMEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MEDICAL ASSISTANT
Provider Gender Code:
F

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:
1164694345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7007 GRAHAM ROAD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-820-3565
Provider Business Mailing Address Fax Number:
317-375-6470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7007 GRAHAM ROAD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46220-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-820-3565
Provider Business Practice Location Address Fax Number:
317-375-6470
Provider Enumeration Date:
03/28/2008

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: 376K00000X , with the licence number:  48-01-04-05216 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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