Organization
SEASIDE SANCTUARY CLINIC LLC
Active
Other names
MARY C. MEADOWS, N.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARY C MEADOWS N.D. (DIRECTOR)
(361) 463-1353
Entity
Organization
Contact information
Practice address
2401 W ROUTE 66, #24, FLAGSTAFF, AZ 86001-8761
(361) 463-1353
(215) 261-0666
Mailing address
2401 W ROUTE 66, #24, FLAGSTAFF, AZ 86001-8761
(361) 463-1353
(215) 261-0666
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K6250
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033LT
BCBS
TX
Enumeration date
01/12/2007
Last updated
08/22/2020
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