Provider Demographics
NPI:1619923646
Name:MERIDIAN HMA LLC
Entity Type:Organization
Organization Name:MERIDIAN HMA LLC
Other - Org Name:RILEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3167
Mailing Address - Street 1:1102 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4001
Mailing Address - Country:US
Mailing Address - Phone:601-693-2511
Mailing Address - Fax:601-484-3130
Practice Address - Street 1:1102 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-693-2511
Practice Address - Fax:601-484-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12249282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010187OtherAL BLUE CROSS
ALHOS0081PMedicaid
LA1729329Medicaid
MS20148OtherBLUE CROSS
MS0220495Medicaid
ALHOS0081PMedicaid