Provider Demographics
NPI:1861408692
Name:MERAKEY WOODHAVEN
Entity type:Organization
Organization Name:MERAKEY WOODHAVEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-836-3131
Mailing Address - Street 1:620 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1810
Mailing Address - Country:US
Mailing Address - Phone:610-260-4600
Mailing Address - Fax:610-260-4618
Practice Address - Street 1:620 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1810
Practice Address - Country:US
Practice Address - Phone:610-260-4600
Practice Address - Fax:610-260-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA116090261Q00000X
PA597200LSCUID9720261Q00000X
PA300519545261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center