MEDICARE: MISS MELISSA L MERRITT IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1164656625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA L MERRITT IDMT

Provider Business Mailing Address
First Line	:	PSC 54 BOX 1559
Second Line	:
City	:	APO
State	:	AE
Zip	:	09601-0016
Country	:	US
Telephone Number	:	00390434306248
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 MDG/MSGS
Second Line	:
City	:	APO
State	:	AE
Zip	:	09601
Country	:	US
Telephone Number	:	00390434306248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/13/2009

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