Provider Demographics
NPI:1790257442
Name:SAMUEL G. MEREDITH MD PA
Entity Type:Organization
Organization Name:SAMUEL G. MEREDITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKILLERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-735-4400
Mailing Address - Street 1:1229 STATE HIGHWAY 77 STE 1
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9050
Mailing Address - Country:US
Mailing Address - Phone:870-735-4400
Mailing Address - Fax:870-735-4412
Practice Address - Street 1:1229 STATE HIGHWAY 77 STE 1
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9050
Practice Address - Country:US
Practice Address - Phone:870-735-4400
Practice Address - Fax:870-735-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty