Provider Demographics
NPI:1225558075
Name:BILDZUKEWICZ, MEAGAN LYNN (PA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LYNN
Last Name:BILDZUKEWICZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4613
Mailing Address - Country:US
Mailing Address - Phone:940-249-9009
Mailing Address - Fax:940-626-8674
Practice Address - Street 1:2014 BEN MERRITT DR STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3851
Practice Address - Country:US
Practice Address - Phone:940-249-9009
Practice Address - Fax:940-626-8674
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378506501Medicaid
TX8HJ264OtherBCBSTX