1770051500 NPI number — CALE CORTLAN MERKLEY MSW

Table of content: CALE CORTLAN MERKLEY MSW (NPI 1770051500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770051500 NPI number — CALE CORTLAN MERKLEY MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERKLEY
Provider First Name:
CALE
Provider Middle Name:
CORTLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

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:
1770051500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 TOWER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLANDVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65669-8333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-270-1469
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65753-8104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-634-4203
Provider Business Practice Location Address Fax Number:
417-634-4505
Provider Enumeration Date:
11/09/2018

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: 101YM0800X , with the licence number:  LH60897094 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LW60563503 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 2024017912 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2116222 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com