Provider Demographics
NPI:1821058256
Name:MECKLEY, JANET SUE (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SUE
Last Name:MECKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8862
Mailing Address - Fax:765-935-8863
Practice Address - Street 1:535 W EATON PIKE
Practice Address - Street 2:STATE LINE FAMILY MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2641
Practice Address - Country:US
Practice Address - Phone:765-935-8862
Practice Address - Fax:765-935-8863
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041137207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000938984OtherANTHEM
IN100389350Medicaid
IN000000938984OtherANTHEM