Provider Demographics
NPI:1689454191
Name:MEADOW MOUNTAIN HEALTH, LLC
Entity Type:Organization
Organization Name:MEADOW MOUNTAIN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:TREGO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:410-726-1443
Mailing Address - Street 1:8739 ROCK LODGE RD
Mailing Address - Street 2:
Mailing Address - City:ACCIDENT
Mailing Address - State:MD
Mailing Address - Zip Code:21520-1126
Mailing Address - Country:US
Mailing Address - Phone:410-726-1443
Mailing Address - Fax:
Practice Address - Street 1:8739 ROCK LODGE RD
Practice Address - Street 2:
Practice Address - City:ACCIDENT
Practice Address - State:MD
Practice Address - Zip Code:21520-1126
Practice Address - Country:US
Practice Address - Phone:410-726-1443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty