CLYDE EDWARD MERRILL PA-C NPI 1497910533

NPI Information

NPI: 1497910533
Provider Name: CLYDE EDWARD MERRILL, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Organization: BANNER CANCER CENTER SPECIALISTS LLC

PECOS Registration: Yes

Address:
2946 E BANNER GATEWAY DR
GILBERT, AZ
ZIP 85234
Phone: (480) 256-6444
Get Directions

Clyde Edward Merrill, PA-C is a surgical physician assistant in Gilbert, AZ with 19 years of experience. Clyde Edward Merrill, PA-C NPI is 1497910533. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2946 E BANNER GATEWAY DR
GILBERT, AZ
ZIP 85234-165
Phone: (480) 256-6444
Fax: (480) 256-4734

The NPI 1497910533 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2008 and was last updated on 3/6/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	01203	WEST VIRGINIA	No
2	363AS0400X	Physician Assistant	Surgical	50.002444	OHIO	No
3	363AS0400X	Physician Assistant	Surgical	5415	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H028170	MEDICARE PIN	OHIO
2	01203	OTHER	WEST VIRGINIA	WV LICENSE
3	000000635240	OTHER	OHIO	ANTHEM
4	0070594	MEDICAID	OHIO
5	35971	MEDICARE PIN	WEST VIRGINIA
6	000000723364	OTHER	OHIO	ANTHEM
7	31512	MEDICARE PIN	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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