Provider Demographics
NPI:1093162570
Name:MERITAS HEALTH CORPORATION
Entity Type:Organization
Organization Name:MERITAS HEALTH CORPORATION
Other - Org Name:MERITAS HEALTH RICHMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NETWORK EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-691-5287
Mailing Address - Street 1:902 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2229
Mailing Address - Country:US
Mailing Address - Phone:816-776-2201
Mailing Address - Fax:816-480-4515
Practice Address - Street 1:902 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2229
Practice Address - Country:US
Practice Address - Phone:816-776-2201
Practice Address - Fax:816-480-4515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERITAS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504636507Medicaid