Healthcare Provider Details

I. General information

NPI: 1932716453
Provider Name (Legal Business Name): MEZA POST ACUTE AND LONG TERM CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 W SELTICE WAY
COEUR D ALENE ID
83814-8989
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:
Mailing address:
  • Phone: 208-819-2183
  • Fax: 208-292-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G MEZA
Title or Position: OWNER
Credential: MD
Phone: 208-819-2183