Provider Demographics
NPI:1659854024
Name:MEDDIVE LLC
Entity type:Organization
Organization Name:MEDDIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-795-0563
Mailing Address - Street 1:900 PARKER SQ STE 250
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7440
Mailing Address - Country:US
Mailing Address - Phone:972-795-0563
Mailing Address - Fax:972-483-2194
Practice Address - Street 1:4351 BOOTH CALLOWAY RD STE 410
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7381
Practice Address - Country:US
Practice Address - Phone:817-255-1170
Practice Address - Fax:817-255-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty