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:904-592-7818
Mailing Address - Street 1:179 COLLEGE DR
Mailing Address - Street 2:STE 17
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7705
Mailing Address - Country:US
Mailing Address - Phone:904-272-7272
Mailing Address - Fax:904-272-7293
Practice Address - Street 1:179 COLLEGE DR
Practice Address - Street 2:STE 17
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7705
Practice Address - Country:US
Practice Address - Phone:904-592-7818
Practice Address - Fax:904-602-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2017-10-25
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