HASTINGS ORTHOPEDIC CLINIC

Provider Demographics

• NPI: 1811197593
• Name: HASTINGS ORTHOPEDIC CLINIC
• Entity type: Organization
• Organization Name: HASTINGS ORTHOPEDIC CLINIC
• Authorized Official - Title/Position: ORTHOPEDIC SURGEON
• Authorized Official - First Name: KENNETH
• Authorized Official - Last Name: MERRIMAN
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 269-945-4966
• Mailing Address - Street 1: 840 COOK RD
• Mailing Address - City: HASTINGS
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49058-9616
• Mailing Address - Country: US
• Mailing Address - Phone: 269-945-4966
• Mailing Address - Fax: 269-945-3368
• Practice Address - Street 1: 840 COOK RD
• Practice Address - City: HASTINGS
• Practice Address - State: MI
• Practice Address - Zip Code: 49058-9616
• Practice Address - Country: US
• Practice Address - Phone: 269-945-4966
• Practice Address - Fax: 269-945-3368
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: HASTINGS ORTHOPEDIC CLINIC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2007-07-20
• Last Update Date: 2008-04-23

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	101378087	Medicaid
MI	114206086	Medicaid
MI	1205872959	Other	ESL NPI
MI	1881639839	Other	JLH NPI
MI	200005744	Other	MCR RR
MI	540Z810220	Other	BCBS DME
MI	200044303	Other	MCR RR
MI	1346373065	Other	GROUP NPI
MI	200Z800130	Other	BCBS GROUP
MI	114316909	Medicaid
MI	1467480152	Other	KSM NPI
MI	1811197593	Other	HOC DME
MI	250011404	Other	MCR RR
MI	874704973	Other	MCD DME
MI	200044303	Other	MCR RR
MI	1881639839	Other	JLH NPI
MI	1811197593	Other	HOC DME
MI	1346373065	Other	GROUP NPI
MI	114206086	Medicaid
MI	0N82650003	Medicare PIN