Provider Demographics
NPI:1225170301
Name:MER EDDY COUNTY, INC.
Entity Type:Organization
Organization Name:MER EDDY COUNTY, INC.
Other - Org Name:CHOICE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & MANAGING EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENNETH
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-885-4805
Mailing Address - Street 1:1004 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4057
Mailing Address - Country:US
Mailing Address - Phone:505-885-4805
Mailing Address - Fax:505-885-8833
Practice Address - Street 1:1415 W AZTEC BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1868
Practice Address - Country:US
Practice Address - Phone:505-334-4016
Practice Address - Fax:505-334-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34228306Medicaid
NM1184480005Medicare ID - Type UnspecifiedPALMETTO REGION C