Provider Demographics
NPI:1932304417
Name:GEORGE W MERKLE MD PC
Entity Type:Organization
Organization Name:GEORGE W MERKLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS
Authorized Official - Phone:260-824-4315
Mailing Address - Street 1:360 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2041
Mailing Address - Country:US
Mailing Address - Phone:260-824-4315
Mailing Address - Fax:260-824-4962
Practice Address - Street 1:360 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-824-4315
Practice Address - Fax:260-824-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023363207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200315120Medicaid
IN200315120Medicaid
INE05878Medicare UPIN