Provider Demographics
NPI:1336134642
Name:MEESE, RODERICK BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:BRYAN
Last Name:MEESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 HOSPITAL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2472
Mailing Address - Country:US
Mailing Address - Phone:931-967-1100
Mailing Address - Fax:
Practice Address - Street 1:186 HOSPITAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2472
Practice Address - Country:US
Practice Address - Phone:931-967-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52365207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C19262Medicare UPIN
TX4534863OtherAETNA
TX060048905Medicare UPIN
TX89420JMedicare PIN
TX89420JOtherBCBS
TX181728304OtherUNITED HEALTHCARE
TX132389101Medicaid