1306876388 NPI number — NORTHSIDE ORTHOPAEDIC CENTER, PC

Table of content: VERONICA LYNN MERIWETHER MSW (NPI 1811027253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306876388 NPI number — NORTHSIDE ORTHOPAEDIC CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSIDE ORTHOPAEDIC CENTER, PC
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:
1306876388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13914 SOUTHEASTERN PKWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46037-7127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-275-1999
Provider Business Mailing Address Fax Number:
317-275-1945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13914 SOUTHEASTERN PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46037-7127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-275-1999
Provider Business Practice Location Address Fax Number:
317-275-1945
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAVENEY
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
317-275-1999

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200373990A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5506996 . This is a "CIGNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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