Provider Demographics
NPI:1194847830
Name:MERLIN D BROWN MD PC
Entity Type:Organization
Organization Name:MERLIN D BROWN MD PC
Other - Org Name:TRINITY FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-232-0743
Mailing Address - Street 1:6503 N US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1048
Mailing Address - Country:US
Mailing Address - Phone:816-232-0743
Mailing Address - Fax:816-364-4151
Practice Address - Street 1:6503 N US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1048
Practice Address - Country:US
Practice Address - Phone:816-232-0743
Practice Address - Fax:816-364-4151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERLIN D BROWN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507490506Medicaid
MOCK9030OtherRR MEDICARE
M400000Medicare PIN
MOCK9030OtherRR MEDICARE