MEDICARE: EDMENT, LLC

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	2003013945	MO

General Provider Information

NPI Number	:	1407047178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMENT, LLC

Provider Business Mailing Address
First Line	:	5780 HIGHWAY 54
Second Line	:	SUITE 113
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3043
Country	:	US
Telephone Number	:	573-348-2775
Fax Number	:	573-348-1284

Provider Business Practice Location Address
First Line	:	5780 HIGHWAY 54
Second Line	:	SUITE 113
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3043
Country	:	US
Telephone Number	:	573-348-2775
Fax Number	:	573-348-1284

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERICH DANIEL MERTENSMEYER
Credential	:	D.O.
Telephone Number	:	573-348-2775

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	05/21/2010

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Directions to “EDMENT, LLC ” Practice Location

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