1942285564 NPI number — EYE CLINIC OF MERIDIAN PLLC

Table of content: (NPI 1942285564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942285564 NPI number — EYE CLINIC OF MERIDIAN PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CLINIC OF MERIDIAN PLLC
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:
1942285564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1551
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:
39302-1551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-485-2368
Provider Business Mailing Address Fax Number:
601-693-2174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 20TH AVE
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:
39301-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-485-2368
Provider Business Practice Location Address Fax Number:
601-693-2174
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARASCALCO
Authorized Official First Name:
DON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
601-485-2368

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051550437 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009943235 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180041975 . This is a "DR MASON-RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 00880212 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051550436 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00116589 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00116642 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051554358 . This is a "DR JOHNSON-RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 180041976 . This is a "DR MARASCALCO-RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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