Provider Demographics
NPI:1568416295
Name:ANESTHESIOLOGIST GROUP OF HENRY COUNTY
Entity Type:Organization
Organization Name:ANESTHESIOLOGIST GROUP OF HENRY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-521-0890
Mailing Address - Street 1:2001 N GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2110
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-213-3240
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-0890
Practice Address - Fax:765-521-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200063800AMedicaid
IN200213450Medicaid
IN200231490Medicaid
IN200198950Medicaid
IN200402470AMedicaid
IN200402470AMedicaid
199120BMedicare ID - Type UnspecifiedARTHUR RATCLIFFE, MD
IN200198950Medicaid
199120Medicare ID - Type UnspecifiedAGHC GROUP #
IN200213450Medicaid
INCB9220Medicare PIN
IN200063800AMedicaid