=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831453018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMIAMI CANAL EMERGENCY PHYSICIANS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2012
-----------------------------------------------------
Last Update Date | 06/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5959 NW 7TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-265-6465
-----------------------------------------------------
Fax | 305-265-6452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13737 NOEL RD STE 1600
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-401-2386
-----------------------------------------------------
Fax | 214-712-2444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. TERRY R. MEADOWS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 469-401-2386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------