MEDICARE: MERCI, 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	363AM0700X	Medical Physician Assistant	PA03871	TX
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1528413820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCI, LLC

Provider Business Mailing Address
First Line	:	PO BOX 427
Second Line	:
City	:	ALTO
State	:	TX
Zip	:	75925-0427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 BUSY BEE
Second Line	:
City	:	ALTO
State	:	TX
Zip	:	75925
Country	:	US
Telephone Number	:	936-642-0841
Fax Number	:

Authorized Official
Title or Position	:	CLINIC SUPERVISOR
Name	:	CANDICE DAVIS
Credential	:
Telephone Number	:	936-642-0841

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	08/22/2022

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