MEDICARE: META VIE INCORPORATED

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	174H00000X	Health Educator	209.005824	IL

General Provider Information

NPI Number	:	1235473901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	META VIE INCORPORATED

Provider Business Mailing Address
First Line	:	101 OAK VALLEY DR
Second Line	:
City	:	GOODFIELD
State	:	IL
Zip	:	61742-9502
Country	:	US
Telephone Number	:	309-678-4253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-2718
Country	:	US
Telephone Number	:	309-678-1443
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWN SNIDER
Credential	:
Telephone Number	:	309-263-4673

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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