Provider Demographics
NPI:1114079639
Name:THOMAS O. MCMEEKIN, M.D., P.C.
Entity Type:Organization
Organization Name:THOMAS O. MCMEEKIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-424-6770
Mailing Address - Street 1:300 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1606
Mailing Address - Country:US
Mailing Address - Phone:585-424-6770
Mailing Address - Fax:585-424-6776
Practice Address - Street 1:300 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1606
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120151-1174400000X
NY197921-1174400000X
NY230724174400000X
NY33554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16828AMedicare ID - Type Unspecified
NYF72919Medicare UPIN
NYB72410Medicare UPIN
NYG49816Medicare UPIN