Healthcare Provider Details

I. General information

NPI: 1356451462
Provider Name (Legal Business Name): MEACHAM ENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W CROMWELL STE 118
FRESNO CA
93711-5844
US

IV. Provider business mailing address

323 W CROMWELL AVE STE 118
FRESNO CA
93711-6166
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-4488
  • Fax: 559-438-4238
Mailing address:
  • Phone: 559-438-4488
  • Fax: 559-438-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number45316
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GERALD L SALAZAR
Title or Position: CEO
Credential:
Phone: 559-438-4488