Provider Demographics
NPI:1891785093
Name:MEINEKE, TERRANCE LEROY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:LEROY
Last Name:MEINEKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:801 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:GEORGE WEST
Practice Address - State:TX
Practice Address - Zip Code:78022-3866
Practice Address - Country:US
Practice Address - Phone:361-449-1947
Practice Address - Fax:361-449-1957
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-00029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164729901Medicaid
TX286742601Medicaid
TXTXB137822Medicare PIN