Basic Information
| Provider Information | |||||||||
| NPI: | 1932725215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEZA POST ACUTE AND LONG TERM CARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3687 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838162529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088192183 | ||||||||
| FaxNumber: | 2082096063 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 E FERNAN HILL RD | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838147588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088192183 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2020 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEZA | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2088192183 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.