Provider Demographics
NPI:1306822960
Name:MERIDIAN ARTS SURGICAL GROUP VASCULAR LAB, LLC
Entity Type:Organization
Organization Name:MERIDIAN ARTS SURGICAL GROUP VASCULAR LAB, LLC
Other - Org Name:MASG VASCULAR LAB, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUNCK
Authorized Official - Suffix:
Authorized Official - Credentials:EFPM, CAPPM
Authorized Official - Phone:601-485-4443
Mailing Address - Street 1:2111 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4041
Mailing Address - Country:US
Mailing Address - Phone:601-693-3834
Mailing Address - Fax:601-484-3225
Practice Address - Street 1:2111 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4041
Practice Address - Country:US
Practice Address - Phone:601-693-3834
Practice Address - Fax:601-484-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory