1952739229 NPI number — MERIDIAN WEIGHT MANAGEMENT CENTER

Table of content: (NPI 1952739229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952739229 NPI number — MERIDIAN WEIGHT MANAGEMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN WEIGHT MANAGEMENT CENTER
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:
1952739229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 23RD AVE
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:
39301-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-696-6736
Provider Business Mailing Address Fax Number:
601-696-6778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 23RD 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:
39301-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-696-6736
Provider Business Practice Location Address Fax Number:
601-696-6778
Provider Enumeration Date:
10/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BONNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
601-696-6736

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  17693 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009933895 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73012009 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 930002774 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00755091 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00071956 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com