Provider Demographics
NPI:1740424209
Name:MERRICK PLASTIC AND HAND SURGERY SC
Entity Type:Organization
Organization Name:MERRICK PLASTIC AND HAND SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-563-1588
Mailing Address - Street 1:1110 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6133
Mailing Address - Country:US
Mailing Address - Phone:715-514-2550
Mailing Address - Fax:715-514-2558
Practice Address - Street 1:1110 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6133
Practice Address - Country:US
Practice Address - Phone:715-514-2550
Practice Address - Fax:715-514-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48417-0202082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34672400Medicaid
WIH28756Medicare UPIN