Healthcare Provider Details

I. General information

NPI: 1861867426
Provider Name (Legal Business Name): MEZA CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 N MERRITT CREEK LOOP STE A
COEUR D ALENE ID
83814-4961
US

IV. Provider business mailing address

PO BOX 3687
COEUR D ALENE ID
83816-2529
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-2183
  • Fax: 208-209-6063
Mailing address:
  • Phone: 208-819-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-966-4437