Provider Demographics
NPI:1962682468
Name:MERIDIAN IMAGING, PA
Entity Type:Organization
Organization Name:MERIDIAN IMAGING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STACY
Authorized Official - Last Name:THAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-693-5843
Mailing Address - Street 1:PO BOX 5653
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5653
Mailing Address - Country:US
Mailing Address - Phone:601-693-5843
Mailing Address - Fax:601-693-0173
Practice Address - Street 1:1102 CONSTITUTION AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-693-5843
Practice Address - Fax:601-693-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty