Provider Demographics
NPI:1851726228
Name:MERIT HEALTHCARE INC.
Entity type:Organization
Organization Name:MERIT HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-6561
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:200-093
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6784
Mailing Address - Country:US
Mailing Address - Phone:760-242-6561
Mailing Address - Fax:760-242-1354
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY
Practice Address - Street 2:200-093
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6784
Practice Address - Country:US
Practice Address - Phone:760-242-6561
Practice Address - Fax:760-242-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty