Healthcare Provider Details

I. General information

NPI: 1215216908
Provider Name (Legal Business Name): MEDERI SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 RINGROSE DR
MISSOURI CITY TX
77459-2918
US

IV. Provider business mailing address

PO BOX 17774
SUGAR LAND TX
77496-7774
US

V. Phone/Fax

Practice location:
  • Phone: 877-563-3374
  • Fax: 713-300-6331
Mailing address:
  • Phone: 877-563-3374
  • Fax: 713-300-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00398
License Number StateTX

VIII. Authorized Official

Name: DAVID BARTCZAK
Title or Position: PRESIDENT
Credential:
Phone: 877-563-3374