Meddive LLC

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

Legal business name

MEDDIVE LLC

Practice address

4351 Booth Calloway Rd Ste 410
North Richland Hills, TX 76180-7381

Phone

(817) 255-1170

Fax

(817) 255-1171

NPI assigned

Sep 12, 2018

Last updated

Sep 12, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Johnston

Title

Sr. Vice President

Phone

(972) 795-0563

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1659854024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 PARKER SQ STE 250",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750287440",
            "telephone_number": "972-795-0563",
            "fax_number": "972-483-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4351 BOOTH CALLOWAY RD STE 410",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761807381",
            "telephone_number": "817-255-1170",
            "fax_number": "817-255-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDDIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-12",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT",
        "authorized_official_telephone_number": "972-795-0563",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in North Richland Hills, TX
• Providers in North Richland Hills, TX by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.