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NPI Code Detail

MEDICARE: MEGAN ELDRIDGE

MEDICARE: MEGAN ELDRIDGE
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
1172V00000XCommunity Health Worker
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1457815045
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN ELDRIDGE
Provider Business Mailing Address
First Line : 1105 W RUSSELL ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-1322
Country : US
Telephone Number : 605-271-2690
Fax Number :
Provider Business Practice Location Address
First Line : 6033 FASHION POINT DR
Second Line :
City : SOUTH OGDEN
State : UT
Zip : 84403-4847
Country : US
Telephone Number : 801-549-8821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2019
Last Update Date : 10/26/2022

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