MEDICARE: JOSE E MERCED MD 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	261QM2500X	Medical Specialty Clinic/Center	021815	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780879015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE E MERCED MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 81023
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70598-1023
Country	:	US
Telephone Number	:	337-769-3002
Fax Number	:	337-769-0309

Provider Business Practice Location Address
First Line	:	433 LA NEUVILLE RD
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-5212
Country	:	US
Telephone Number	:	337-769-3002
Fax Number	:	337-769-0309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE EDGARDO MERCED
Credential	:	M.D.
Telephone Number	:	337-769-3002

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	06/26/2008

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