MEDICARE: MERCARIK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333300000X	Emergency Response System Companies
2	225CA2500X	Assistive Technology Supplier Rehabilitation Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A867965200	OTHER	MN	UNIQUE MINNESOTA PROVIDER IDENTIFIER

General Provider Information

NPI Number	:	1255038105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCARIK INC

Provider Business Mailing Address
First Line	:	1391 IOWA AVE W
Second Line	:
City	:	FALCON HEIGHTS
State	:	MN
Zip	:	55108-2122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1391 IOWA AVE W
Second Line	:
City	:	FALCON HEIGHTS
State	:	MN
Zip	:	55108-2122
Country	:	US
Telephone Number	:	651-270-8871
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	MATTHEW HANSEN
Credential	:
Telephone Number	:	651-270-8871

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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