Provider Demographics
NPI:1679649974
Name:PODIATRY ASSOCIATES OF MERIDIAN, PLLC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF MERIDIAN, PLLC
Other - Org Name:FOOT CLINIC OF MERIDIAN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HANEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-483-6134
Mailing Address - Street 1:1300 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3916
Mailing Address - Country:US
Mailing Address - Phone:601-483-6134
Mailing Address - Fax:601-483-7247
Practice Address - Street 1:1300 25TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3916
Practice Address - Country:US
Practice Address - Phone:601-483-6134
Practice Address - Fax:601-483-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80165213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDD3897OtherMEDICARE RAILROAD
MSRR9179OtherMEDICARE RAILROAD
MS5480320001Medicare NSC
MSRR9179OtherMEDICARE RAILROAD