Provider Demographics
NPI:1346608742
Name:MEADOWCREST PHYSICIANS PARTNERS LLC
Entity Type:Organization
Organization Name:MEADOWCREST PHYSICIANS PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-795-0644
Mailing Address - Street 1:6199 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-2679
Mailing Address - Country:US
Mailing Address - Phone:352-795-0644
Mailing Address - Fax:352-795-5950
Practice Address - Street 1:6199 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2679
Practice Address - Country:US
Practice Address - Phone:352-795-0644
Practice Address - Fax:352-795-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty