Basic Information
| Provider Information | |||||||||
| NPI: | 1699130682 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERIDA HEALTHCARE OF MIDLAND LLC | ||||||||
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| OtherOrganizationName: | MERIDA HEALTH CARE GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785511230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564231197 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2109 W TEXAS AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797016400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326860900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | MESQUIAS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | YSA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9562451552 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 012304 | TX | Y | Agencies | Home Health |
No ID Information.