Provider Demographics
NPI:1700963188
Name:MEIVIS HEALTH LLC
Entity Type:Organization
Organization Name:MEIVIS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-351-5660
Mailing Address - Street 1:7232 W SAND LAKE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5260
Mailing Address - Country:US
Mailing Address - Phone:407-351-5660
Mailing Address - Fax:407-363-6707
Practice Address - Street 1:7232 W SAND LAKE RD
Practice Address - Street 2:STE 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5260
Practice Address - Country:US
Practice Address - Phone:407-351-5660
Practice Address - Fax:407-363-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54672Medicare ID - Type UnspecifiedID # FOR PRIMARY