Healthcare Provider Details

I. General information

NPI: 1598892861
Provider Name (Legal Business Name): MERRITT RADIOLOGICAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 CHARITY WAY
MODESTO CA
95356
US

IV. Provider business mailing address

PO BOX 906
SALIDA CA
95368
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-9900
  • Fax: 209-577-1509
Mailing address:
  • Phone: 209-577-9900
  • Fax: 209-577-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J CROUTCH
Title or Position: PRESIDENT
Credential: MD
Phone: 209-577-9900