Provider Demographics
NPI:1710470265
Name:MEADOWS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:MEADOWS MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-271-5913
Mailing Address - Street 1:700 E FIRMIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2375
Mailing Address - Country:US
Mailing Address - Phone:765-271-5913
Mailing Address - Fax:
Practice Address - Street 1:700 E FIRMIN ST STE 212
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2375
Practice Address - Country:US
Practice Address - Phone:765-271-5913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010609862080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical ToxicologyGroup - Single Specialty