Provider Demographics
NPI:1689263634
Name:MEGAN BOOTH LLC
Entity Type:Organization
Organization Name:MEGAN BOOTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:BROOKING
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:928-284-2116
Mailing Address - Street 1:6446 STATE ROUTE 179 STE 209
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7991
Mailing Address - Country:US
Mailing Address - Phone:928-284-2116
Mailing Address - Fax:
Practice Address - Street 1:6446 STATE ROUTE 179 STE 209
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7991
Practice Address - Country:US
Practice Address - Phone:928-284-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech