1790764413 NPI number — MERIDIAN MEDICAL SUPPLY, INC

Table of content: MRS. DIANE NAVARRE LMT, NCBTMB (NPI 1306289038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790764413 NPI number — MERIDIAN MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN MEDICAL SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790764413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 MONTANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-5719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-351-2525
Provider Business Mailing Address Fax Number:
915-351-1970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 MONTANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-351-2525
Provider Business Practice Location Address Fax Number:
915-351-1970
Provider Enumeration Date:
01/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PONICKI
Authorized Official First Name:
CECILIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
915-351-2525

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)