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General NPI Number Information
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NPI Number | 1265870752
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Entity Type | Organization
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Legal Business Name | MERIDIAN MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 5975 W SUNRISE BLVD SUITE 106
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City | PLANTATION
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State | FL
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Zip | 33313-6801
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Country | US
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Telephone | 954-200-8362
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Fax | 954-206-4458
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Provider Business Mailing Address
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Address Line | 5975 W SUNRISE BLVD SUITE 106
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City | PLANTATION
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State | FL
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Zip | 33313-6801
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Country | US
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Telephone | 954-200-8362
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Fax | 954-206-4458
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADEILSON JORGE
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Credential |
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Telephone | 754-200-8362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | FL
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