Provider Demographics
NPI:1346489457
Name:CHILDREN'S CLINIC OF MERIDIAN
Entity Type:Organization
Organization Name:CHILDREN'S CLINIC OF MERIDIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNERA-CORDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-282-5346
Mailing Address - Street 1:1430 HWY 19 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5378
Mailing Address - Country:US
Mailing Address - Phone:601-282-5346
Mailing Address - Fax:601-282-5347
Practice Address - Street 1:1430 HWY 19 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5378
Practice Address - Country:US
Practice Address - Phone:601-282-5346
Practice Address - Fax:601-282-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17363261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)