MEDICARE: MERRILL CLINIC

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	261QP2300X	Primary Care Clinic/Center	93006519	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R162513	OTHER	OR	MEDICARE NUMBER

General Provider Information

NPI Number	:	1730181926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRILL CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 1030
Second Line	:
City	:	MERRILL
State	:	OR
Zip	:	97633-1030
Country	:	US
Telephone Number	:	541-798-5074
Fax Number	:	541-798-5076

Provider Business Practice Location Address
First Line	:	125 NORTH LINCOLN STREET
Second Line	:
City	:	MERRILL
State	:	OR
Zip	:	97633-0000
Country	:	US
Telephone Number	:	541-798-5074
Fax Number	:	541-798-5076

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	MR. MICHAEL AARON SHEETS
Credential	:	FNP
Telephone Number	:	541-545-1820

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/05/2024

Similar Medicare Providers

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Practice Location Address:

125 N LINCOLN ST
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97633

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1801953336 — THOMAS JAMES BENTLEY PT
Practice Location Address:

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1558131797 — BENTLEY PHYSICAL THERAPY LLC
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Directions to “MERRILL CLINIC ” Practice Location

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