Provider Demographics
NPI:1609934058
Name:MERIDIAN HMA INC
Entity Type:Organization
Organization Name:MERIDIAN HMA INC
Other - Org Name:RILEY WOMENS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-484-3590
Mailing Address - Street 1:1020 22ND AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-692-2220
Mailing Address - Fax:601-692-2234
Practice Address - Street 1:1020 22ND AVENUE
Practice Address - Street 2:STE A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-692-2220
Practice Address - Fax:601-692-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016173Medicaid