Provider Demographics
NPI:1467937029
Name:MEA PRIMARY CARE PLUS, LLC
Entity Type:Organization
Organization Name:MEA PRIMARY CARE PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-898-7530
Mailing Address - Street 1:106 LAKE VISTA PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6384
Mailing Address - Country:US
Mailing Address - Phone:601-919-2924
Mailing Address - Fax:601-992-7347
Practice Address - Street 1:106 LAKE VISTA PL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6384
Practice Address - Country:US
Practice Address - Phone:601-919-2924
Practice Address - Fax:601-992-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty