1386073872 NPI number — MEADOWVIEW PHYSICIAN PRACTICE LLC

Table of content: (NPI 1386073872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386073872 NPI number — MEADOWVIEW PHYSICIAN PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWVIEW PHYSICIAN PRACTICE LLC
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:
6
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:
1386073872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
991 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MAYSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41056-8764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-759-5424
Provider Business Mailing Address Fax Number:
606-759-7314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
991 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MAYSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41056-8764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-759-5424
Provider Business Practice Location Address Fax Number:
606-759-7314
Provider Enumeration Date:
11/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JUDY
Authorized Official First Name:
JESS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-372-8500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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