Provider Demographics
NPI:1225271166
Name:MELIORA FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:MELIORA FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-664-6116
Mailing Address - Street 1:172 HUDSON AVE
Mailing Address - Street 2:PO BOX 173
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170
Mailing Address - Country:US
Mailing Address - Phone:877-664-6116
Mailing Address - Fax:877-664-6116
Practice Address - Street 1:172 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170
Practice Address - Country:US
Practice Address - Phone:877-664-6116
Practice Address - Fax:877-664-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA247491261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care