1962682468 NPI number — MERIDIAN IMAGING, PA

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 1962682468 NPI number — MERIDIAN IMAGING, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN IMAGING, 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:
1962682468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5653
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:
39302-5653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-693-5843
Provider Business Mailing Address Fax Number:
601-693-0173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 CONSTITUTION AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-693-5843
Provider Business Practice Location Address Fax Number:
601-693-0173
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THAGGARD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
STACY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
601-693-5843

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com