1215333604 NPI number — MEREDITH FLEMING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215333604 NPI number — MEREDITH FLEMING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
MEREDITH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1215333604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 E MASON ST
Provider Second Line Business Mailing Address:
SUITE 4P57
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62701-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-788-0706
Provider Business Mailing Address Fax Number:
217-525-2535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 E MASON ST
Provider Second Line Business Practice Location Address:
SUITE 4P57
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62701-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-788-0706
Provider Business Practice Location Address Fax Number:
217-525-2535
Provider Enumeration Date:
11/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  209.012172 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 209012172 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01443040 . This is a "RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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