Provider Demographics
NPI:1922250455
Name:FIRST MERIDIAN MEDICAL LLC
Entity Type:Organization
Organization Name:FIRST MERIDIAN MEDICAL LLC
Other - Org Name:MRI & CT DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-965-4151
Mailing Address - Street 1:1554 RIVER BIRCH RUN N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7500
Mailing Address - Country:US
Mailing Address - Phone:757-965-4151
Mailing Address - Fax:757-965-4168
Practice Address - Street 1:1554 RIVER BIRCH RUN N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7500
Practice Address - Country:US
Practice Address - Phone:757-671-1144
Practice Address - Fax:757-671-7299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST MERIDIAN MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty