Provider Demographics
NPI:1326105933
Name:MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA
Entity Type:Organization
Organization Name:MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA
Other - Org Name:EASTERN CAROLINA ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-353-3535
Mailing Address - Street 1:46 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3217
Mailing Address - Country:US
Mailing Address - Phone:910-353-3535
Mailing Address - Fax:910-353-9754
Practice Address - Street 1:46 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3217
Practice Address - Country:US
Practice Address - Phone:910-353-3535
Practice Address - Fax:910-353-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3953204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
744032OtherUCCI
NC02601OtherBCBS GROUP #
NC8902601Medicaid
NC241058AMedicare ID - Type Unspecified
NC2428433Medicare PIN
NCT63801Medicare UPIN
NC8902601Medicaid