Provider Demographics
NPI:1194865220
Name:THE MERTON GROUP
Entity Type:Organization
Organization Name:THE MERTON GROUP
Other - Org Name:MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-966-7611
Mailing Address - Street 1:W314 N7668 HIGHMAY 83
Mailing Address - Street 2:P. O. BOX 302
Mailing Address - City:NORTH LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53064-0302
Mailing Address - Country:US
Mailing Address - Phone:414-966-7611
Mailing Address - Fax:262-727-7009
Practice Address - Street 1:W314 N7668 HIGHMAY 83
Practice Address - Street 2:
Practice Address - City:NORTH LAKE
Practice Address - State:WI
Practice Address - Zip Code:53064-0302
Practice Address - Country:US
Practice Address - Phone:414-966-7611
Practice Address - Fax:262-727-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41739700Medicaid
WI5101590001Medicare ID - Type Unspecified