Provider Demographics
NPI:1164491767
Name:JAMES T. MEREDITH JR MD PA
Entity Type:Organization
Organization Name:JAMES T. MEREDITH JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THEROLD
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-633-4711
Mailing Address - Street 1:921 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-9183
Mailing Address - Country:US
Mailing Address - Phone:870-633-4711
Mailing Address - Fax:870-633-4850
Practice Address - Street 1:921 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-9183
Practice Address - Country:US
Practice Address - Phone:870-633-4711
Practice Address - Fax:870-633-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC0977305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106020002Medicaid
SCDG5130OtherRAILROAD MEDICARE
ARD84281Medicare UPIN
SCDG5130Medicare PIN
SCDG5130Medicare PIN