Provider Demographics
NPI:1164433678
Name:MERIDIAN ONCOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MERIDIAN ONCOLOGY ASSOCIATES PLLC
Other - Org Name:MATTHEW CASSELL, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-482-1555
Mailing Address - Street 1:1704 23RD AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1704 23RD AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3103
Practice Address - Country:US
Practice Address - Phone:601-482-1555
Practice Address - Fax:601-696-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20329332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
2586610OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2586610OtherOTHER ID NUMBER
MS5939260001OtherPTAN
MSCF9149OtherRAILROAD GROUP #