Provider Demographics
NPI:1124050711
Name:MEADOWLANDS MEDICAL CENTER, PA
Entity type:Organization
Organization Name:MEADOWLANDS MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:ALESSANDRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-706-1636
Mailing Address - Street 1:1871 SENTRY OAK CT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3775
Mailing Address - Country:US
Mailing Address - Phone:904-706-1636
Mailing Address - Fax:904-592-1322
Practice Address - Street 1:1543 KINGSLEY AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-706-1636
Practice Address - Fax:904-592-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70009261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72398OtherBLUE CROSS
FL265625600Medicaid
FL72398OtherBLUE CROSS