Provider Demographics
NPI:1598762841
Name:MELOY, NATHAN C (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
Last Name:MELOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MAPLECREST RD STE 12
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2799
Mailing Address - Country:US
Mailing Address - Phone:563-421-3555
Mailing Address - Fax:
Practice Address - Street 1:2535 MAPLECREST RD STE 12
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2799
Practice Address - Country:US
Practice Address - Phone:563-421-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112357207LP2900X
MI5101017187208VP0014X
WI51723-21208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4999459-11Medicaid
MI5207874-11Medicaid
MI556315665OtherBLUE CROSS BLUE SHIELD
MI4999459-11Medicaid
MIN29240009Medicare PIN