Provider Demographics
NPI:1659472488
Name:GREATER MERIDIAN HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:GREATER MERIDIAN HEALTH CLINIC, INC
Other - Org Name:GREATER MERIDIAN HEALTH CLINIC, INC. HOSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-693-0118
Mailing Address - Street 1:2701 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5708
Mailing Address - Country:US
Mailing Address - Phone:601-693-0118
Mailing Address - Fax:601-693-2988
Practice Address - Street 1:2701 DAVIS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5708
Practice Address - Country:US
Practice Address - Phone:601-693-0118
Practice Address - Fax:601-693-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC00916OtherCAHABA
MS09012091Medicaid
MS09012091Medicaid