Basic Information
| Provider Information | |||||||||
| NPI: | 1023453693 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERIDA HOSPICE OF AUSTIN, L.L.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785511230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564231197 | ||||||||
| FaxNumber: | 9564401837 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 CLAYTON LN STE 110W | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787232472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889949516 | ||||||||
| FaxNumber: | 8003032529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | MESQUIAS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | Y. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9564231197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.