1871702464 NPI number — DENNIS WILLIAM MERSKI D.O.

Table of content: MR. GEORGE A JOSEPH M.D. (NPI 1821152356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871702464 NPI number — DENNIS WILLIAM MERSKI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERSKI
Provider First Name:
DENNIS
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1871702464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 20TH AVE N STE 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-5180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-284-4088
Provider Business Mailing Address Fax Number:
615-284-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1589 SPARTA ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-1392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-473-4714
Provider Business Practice Location Address Fax Number:
931-815-5060
Provider Enumeration Date:
05/21/2007

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: 207VX0000X , with the licence number:  2209 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 34.011034 , 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: Q047309 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0095803 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810026907 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".