Provider Demographics
NPI:1740941327
Name:MERIDIAN REGIONAL DIAGNOSTICS GROUP LLC
Entity type:Organization
Organization Name:MERIDIAN REGIONAL DIAGNOSTICS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-453-3376
Mailing Address - Street 1:100 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5544
Mailing Address - Country:US
Mailing Address - Phone:601-453-3376
Mailing Address - Fax:
Practice Address - Street 1:1001 1ST AVENUE E
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6024
Practice Address - Country:US
Practice Address - Phone:601-453-3376
Practice Address - Fax:601-227-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory