Provider Demographics
NPI:1457442758
Name:MERIDIAN EAR NOSE & THROAT CLINICPA
Entity Type:Organization
Organization Name:MERIDIAN EAR NOSE & THROAT CLINICPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-483-9358
Mailing Address - Street 1:1521 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4016
Mailing Address - Country:US
Mailing Address - Phone:601-483-9358
Mailing Address - Fax:601-483-9664
Practice Address - Street 1:1521 22ND AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4016
Practice Address - Country:US
Practice Address - Phone:601-483-9358
Practice Address - Fax:601-483-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12647207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011227Medicaid
MSCB4634Medicare UPIN
MS09011227Medicaid