Provider Demographics
NPI:1578558185
Name:MEADOWS, WILLARD SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:SCOTT
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0299
Mailing Address - Country:US
Mailing Address - Phone:931-728-5607
Mailing Address - Fax:931-728-8354
Practice Address - Street 1:704 HWY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2111
Practice Address - Country:US
Practice Address - Phone:615-620-2320
Practice Address - Fax:615-620-2323
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYARNP5193A367500000X
TNAPN10816367500000X
TNRN106855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009944350Medicaid
TN3631210Medicaid
TN4206153OtherBLUE CROSS/BLUE SHIELD OF TN - INTEGRATED
TNP00689532OtherRR MEDICARE
TN01259592OtherAMERIGROUP TENNCARE NON-PAR - INTEGRATED
KY74002510Medicaid
TN4206153OtherBLUE CROSS/BLUE SHIELD SAS
TN3161402OtherBC/BS NUMBER
TN1506321Medicaid
AL009944350Medicaid
TN36312162Medicare PIN