1649228800 NPI number — J O MEADOWS MD PA

Table of content: (NPI 1649228800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649228800 NPI number — J O MEADOWS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J O MEADOWS MD PA
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:
1649228800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 RIVERSIDE DRIVE
Provider Second Line Business Mailing Address:
STE B202
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-0600
Provider Business Mailing Address Fax Number:
410-543-9480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 RIVERSIDE DRIVE
Provider Second Line Business Practice Location Address:
STE B202
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-0600
Provider Business Practice Location Address Fax Number:
410-543-9480
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEADOWS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
410-543-0600

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  D19822 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4356826 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S343 . This is a "FED BCBS & BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6067310 . This is a "VA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 733205 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 319987 . This is a "MAMSI UHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0000051301 . This is a "DEL MEDICAID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 5932JO . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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