1184600736 NPI number — MERIDIAN SURGERY CENTER, LLC

Table of content: (NPI 1184600736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184600736 NPI number — MERIDIAN SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184600736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-485-4443
Provider Business Mailing Address Fax Number:
601-485-9060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-485-4443
Provider Business Practice Location Address Fax Number:
601-485-9060
Provider Enumeration Date:
12/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
DON
Authorized Official Middle Name:
LARKIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-703-9614

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07430842 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000050715 . This is a "BLUE CROSS OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".