Provider Demographics
NPI:1821276163
Name:MERITAS MEDICAL, INC
Entity Type:Organization
Organization Name:MERITAS MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-297-1158
Mailing Address - Street 1:100 W THIRD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201
Mailing Address - Country:US
Mailing Address - Phone:614-297-1158
Mailing Address - Fax:614-299-3406
Practice Address - Street 1:2000 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:614-297-1158
Practice Address - Fax:614-299-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty