Provider Demographics
NPI:1912577628
Name:MERTZ MFM CENTER
Entity Type:Organization
Organization Name:MERTZ MFM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-480-4173
Mailing Address - Street 1:3815 FORRESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2930
Mailing Address - Country:US
Mailing Address - Phone:336-480-4173
Mailing Address - Fax:276-783-2879
Practice Address - Street 1:3815 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-480-4173
Practice Address - Fax:276-783-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty