Provider Demographics
NPI:1356539597
Name:JOSEPH M. MEADOWS JR., MD PC
Entity type:Organization
Organization Name:JOSEPH M. MEADOWS JR., MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:734-662-1986
Mailing Address - Street 1:2750 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6179
Mailing Address - Country:US
Mailing Address - Phone:734-662-1986
Mailing Address - Fax:734-662-8904
Practice Address - Street 1:2750 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6179
Practice Address - Country:US
Practice Address - Phone:734-662-1986
Practice Address - Fax:734-662-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301021469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1046130Medicaid
FM0815960Medicare PIN
MI1046130Medicaid