Basic Information
| Provider Information | |||||||||
| NPI: | 1407229495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEFL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1404 S NEW RD | ||||||||
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| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767111335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543156565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1680 SW SAINT LUCIE WEST BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | PORT SAINT LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349861927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723372526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | CARROLL | ||||||||
| AuthorizedOfficialFirstName: | KENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | STAFF ACCOUNTANT | ||||||||
| AuthorizedOfficialTelephone: | 2542275189 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.