Provider Demographics
NPI:1326318486
Name:MERCHO MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:MERCHO MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MERCHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-357-7800
Mailing Address - Street 1:1311 N. ARLINGTON AVENUE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3260
Mailing Address - Country:US
Mailing Address - Phone:317-357-7800
Mailing Address - Fax:317-357-7878
Practice Address - Street 1:1311 N. ARLINGTON AVENUE
Practice Address - Street 2:SUITE 108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3260
Practice Address - Country:US
Practice Address - Phone:317-357-7800
Practice Address - Fax:317-357-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046737305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING67475Medicare UPIN