Basic Information
| Provider Information | |||||||||
| NPI: | 1326156027 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERIT HEALTH CARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2038 | ||||||||
| Address2: | |||||||||
| City: | SYLACAUGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351505038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562490028 | ||||||||
| FaxNumber: | 2562490019 | ||||||||
| Practice Location | |||||||||
| Address1: | 729 BATTLE ST E | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567612955 | ||||||||
| FaxNumber: | 2567612787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | HABACH | ||||||||
| AuthorizedOfficialFirstName: | GHAYAS | ||||||||
| AuthorizedOfficialMiddleName: | ALI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2562490028 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., M.P.H. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 17714 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 529927850 | 05 | AL | MEDICAID | 51536048 | 01 | AL | BCBS - HABACH - CLINIC | OTHER |