Provider Demographics
NPI:1881917961
Name:MERRICARE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:MERRICARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:IFEYINWA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NZEREM
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:317-748-4032
Mailing Address - Street 1:10387 WATER CREST DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7419
Mailing Address - Country:US
Mailing Address - Phone:317-748-4032
Mailing Address - Fax:317-770-8251
Practice Address - Street 1:10387 WATER CREST DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-7419
Practice Address - Country:US
Practice Address - Phone:317-748-4032
Practice Address - Fax:317-770-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies