Provider Demographics
NPI:1982674537
Name:MEANEY, TREVOR
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:MEANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N KIMBALL ST
Mailing Address - Street 2:STE 400
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 N KIMBALL ST
Practice Address - Street 2:STE 400
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1199
Practice Address - Country:US
Practice Address - Phone:605-996-7900
Practice Address - Fax:605-996-7908
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5610982Medicaid
SD5610982Medicaid
P00006436Medicare PIN