Healthcare Provider Details

I. General information

NPI: 1427369040
Provider Name (Legal Business Name): MEP ENTERPRISES OF DELTONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 ALDERWOOD AVE
DELTONA FL
32738-8979
US

IV. Provider business mailing address

753 ALDERWOOD AVE
DELTONA FL
32738-8979
US

V. Phone/Fax

Practice location:
  • Phone: 386-860-7774
  • Fax: 763-322-2548
Mailing address:
  • Phone: 386-860-7774
  • Fax: 763-322-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. MATTIE M PHILLIPS
Title or Position: PRESIDENT
Credential:
Phone: 386-860-7774