1760520274 NPI number — MERIT MEDICAL PRACTICE, PC

Table of content: (NPI 1760520274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760520274 NPI number — MERIT MEDICAL PRACTICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIT MEDICAL PRACTICE, PC
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:
6
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:
1760520274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 HELENDALE RD
Provider Second Line Business Mailing Address:
SUITE 90
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14609-3173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-288-0530
Provider Business Mailing Address Fax Number:
585-288-3363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HELENDALE RD
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14609-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-288-0530
Provider Business Practice Location Address Fax Number:
585-288-3363
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHLOTZHAUER
Authorized Official First Name:
TAMMI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
585-288-0530

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AA0637 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: G0188846590 . This is a "EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02042262 . This is a "MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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