Provider Demographics
NPI:1780267567
Name:TODD MERENIUK, PLLC
Entity type:Organization
Organization Name:TODD MERENIUK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERENIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-432-2061
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-0886
Mailing Address - Country:US
Mailing Address - Phone:504-432-2061
Mailing Address - Fax:
Practice Address - Street 1:504 AZALEA DR DEPT OF
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5397
Practice Address - Country:US
Practice Address - Phone:662-636-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty