Provider Demographics
NPI:1821152596
Name:MEADOWS HEALTHCARE ALLIANCE
Entity Type:Organization
Organization Name:MEADOWS HEALTHCARE ALLIANCE
Other - Org Name:ALLIANCE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-538-5881
Mailing Address - Street 1:1107 E 1ST ST
Mailing Address - Street 2:PO BOX 1915
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4205
Mailing Address - Country:US
Mailing Address - Phone:912-537-6930
Mailing Address - Fax:912-537-6934
Practice Address - Street 1:1107 E 1ST ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4205
Practice Address - Country:US
Practice Address - Phone:912-537-6930
Practice Address - Fax:912-537-6934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEADOWS REGIONAL HOME CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006000651332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA071161916AMedicaid
GA3725180001Medicare ID - Type Unspecified