MEDICARE: MERIDA PROFESSIONAL SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1235212333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDA PROFESSIONAL SERVICES, INC

Provider Business Mailing Address
First Line	:	9280 COLLEGE PKWY
Second Line	:	UNIT 6
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4848
Country	:	US
Telephone Number	:	239-267-1943
Fax Number	:

Provider Business Practice Location Address
First Line	:	9280 COLLEGE PKWY
Second Line	:	UNIT 6
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4848
Country	:	US
Telephone Number	:	239-267-1943
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIDIA E MANTILLA
Credential	:
Telephone Number	:	239-267-1943

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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