MEDICARE: MERITAS SURGICAL, 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	208600000X	Surgery Physician	48932	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	020028676	OTHER		UHC/TRAVLER'S MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1305142	OTHER	FEDERAL BLACK LUNG
2	0007114	OTHER	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538140926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERITAS SURGICAL, INC.

Provider Business Mailing Address
First Line	:	1970 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1363
Country	:	US
Telephone Number	:	740-344-2452
Fax Number	:	740-344-7305

Provider Business Practice Location Address
First Line	:	1970 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1363
Country	:	US
Telephone Number	:	740-344-2452
Fax Number	:	740-344-7305

Authorized Official
Title or Position	:	PRESIDENT, CORPORATION
Name	:	DR. ALEX D JUAN
Credential	:	M.D.
Telephone Number	:	740-344-2452

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/17/2018

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43055-1363

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Directions to “MERITAS SURGICAL, INC. ” Practice Location

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