Provider Demographics
NPI:1477207124
Name:MERIDIAN WELLNESS CENTER
Entity Type:Organization
Organization Name:MERIDIAN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:A MONDELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-961-7395
Mailing Address - Street 1:542 PAUMA VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1917
Mailing Address - Country:US
Mailing Address - Phone:321-961-7395
Mailing Address - Fax:321-242-7679
Practice Address - Street 1:6550 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2049
Practice Address - Country:US
Practice Address - Phone:941-284-5993
Practice Address - Fax:321-242-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty