Provider Demographics
NPI:1356501829
Name:MERIDIAN PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:MERIDIAN PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MASSINGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-553-3645
Mailing Address - Street 1:1400 20TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4111
Mailing Address - Country:US
Mailing Address - Phone:601-553-3645
Mailing Address - Fax:601-553-3127
Practice Address - Street 1:1400 20TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4111
Practice Address - Country:US
Practice Address - Phone:601-553-3645
Practice Address - Fax:601-553-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty