Provider Demographics
NPI:1164639357
Name:MEADOWLOFT, LLC
Entity Type:Organization
Organization Name:MEADOWLOFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-845-8400
Mailing Address - Street 1:19 ANTHONYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504-8811
Mailing Address - Country:US
Mailing Address - Phone:610-845-8400
Mailing Address - Fax:610-845-8426
Practice Address - Street 1:19 ANTHONYS MILL RD
Practice Address - Street 2:
Practice Address - City:BARTO
Practice Address - State:PA
Practice Address - Zip Code:19504-8811
Practice Address - Country:US
Practice Address - Phone:610-845-8400
Practice Address - Fax:610-845-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty