Healthcare Provider Details

I. General information

NPI: 1457626418
Provider Name (Legal Business Name): MEFL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 COLUMBIA BLVD STE B107
TITUSVILLE FL
32780-7865
US

IV. Provider business mailing address

8300 CENTRAL PARK DR STE 100
WACO TX
76712-6666
US

V. Phone/Fax

Practice location:
  • Phone: 321-267-9746
  • Fax:
Mailing address:
  • Phone: 254-227-5189
  • Fax: 254-300-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: KENNY LYNN CARROLL
Title or Position: ADMINISTRATOR
Credential:
Phone: 254-227-5189