Provider Demographics
NPI:1356465561
Name:MEADE O DAVIS III MD PC
Entity Type:Organization
Organization Name:MEADE O DAVIS III MD PC
Other - Org Name:DAVIS ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEADE
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:307-634-0871
Mailing Address - Street 1:PO BOX 20639
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7014
Mailing Address - Country:US
Mailing Address - Phone:307-634-0871
Mailing Address - Fax:307-638-4054
Practice Address - Street 1:433 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4643
Practice Address - Country:US
Practice Address - Phone:307-634-0871
Practice Address - Fax:307-638-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2428A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA73018Medicare UPIN
WY0437900001Medicare NSC
WY4108601Medicare ID - Type Unspecified