Provider Demographics
NPI:1356451462
Name:MEACHAM ENT INC
Entity Type:Organization
Organization Name:MEACHAM ENT INC
Other - Org Name:CENTRAL VALLEY CPM & BRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-438-4488
Mailing Address - Street 1:323 W CROMWELL AVE
Mailing Address - Street 2:STE 118
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6166
Mailing Address - Country:US
Mailing Address - Phone:559-438-4488
Mailing Address - Fax:559-438-4238
Practice Address - Street 1:323 W CROMWELL
Practice Address - Street 2:STE 118
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5844
Practice Address - Country:US
Practice Address - Phone:559-438-4488
Practice Address - Fax:559-438-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45316332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ45760ZOtherBS
CAZZZ45760ZOtherBS
CA0284700001Medicare NSC