Healthcare Provider Details

I. General information

NPI: 1942647342
Provider Name (Legal Business Name): MARK EVERETT MEADOWS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16521 NW 1 AVE.
MIAMI FL
33169
US

IV. Provider business mailing address

16521 NW 1 AVE.
MIAMI FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-7261
  • Fax:
Mailing address:
  • Phone: 305-947-7261
  • Fax: 305-945-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT6702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: