MEDICARE: MERRILL WINCHESTER MD

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	174400000X	Specialist	12693	KY

General Provider Information

NPI Number	:	1487637963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRILL WINCHESTER MD

Provider Business Mailing Address
First Line	:	117 LARAMIE LANE
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653
Country	:	US
Telephone Number	:	606-376-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 MEDICAL LN
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-4216
Country	:	US
Telephone Number	:	606-376-7212
Fax Number	:	606-376-7216

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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Directions to “ MERRILL WINCHESTER MD” Practice Location

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