Basic Information
Provider Information
NPI: 1912577628
EntityType: 2
ReplacementNPI:  
OrganizationName: MERTZ MFM CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 3817 FORRESTGATE DR STE B
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271032930
CountryCode: US
TelephoneNumber: 3364804173
FaxNumber: 2767832879
Practice Location
Address1: 3817 FORRESTGATE DR STE B
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271032930
CountryCode: US
TelephoneNumber: 3364804173
FaxNumber: 2767832879
Other Information
ProviderEnumerationDate: 06/26/2021
LastUpdateDate: 06/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: MERTZ
AuthorizedOfficialFirstName: HEATHER
AuthorizedOfficialMiddleName: L.
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3364804173
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 06/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VM0101X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

No ID Information.


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