Provider Demographics
NPI:1194397851
Name:MEADOWLARK PEDIATRICS, LLC
Entity Type:Organization
Organization Name:MEADOWLARK PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPNP, CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DEPRINCE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:307-314-4242
Mailing Address - Street 1:204 MCCOLLUM ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5127
Mailing Address - Country:US
Mailing Address - Phone:307-314-4242
Mailing Address - Fax:307-460-3331
Practice Address - Street 1:1208 S RIVER ST
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-5204
Practice Address - Country:US
Practice Address - Phone:307-314-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty