Organization
PRAIRIE CREEK RADIOLOGY,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAROUK E MERCHO MD (MEDICAL DIRECTOR)
(812) 234-4642
Entity
Organization
Contact information
Practice address
3901 S 7TH ST, TERRE HAUTE, IN 47802-5709
(812) 234-8261
(812) 234-8262
Mailing address
PO BOX 2125, INDIANAPOLIS, IN 46206-2125
(812) 234-8261
(812) 234-8262
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01031856A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000242179
BLUE CROSS/BLUE SHIELD
IN
Enumeration date
02/06/2007
Last updated
04/09/2008
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