Provider Demographics
NPI:1932399797
Name:MEREDITH, SARAH JOANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JOANNE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8517
Mailing Address - Country:US
Mailing Address - Phone:817-921-6166
Mailing Address - Fax:817-921-9594
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-921-6166
Practice Address - Fax:817-921-9594
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10028341207Q00000X
TXN5244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CU134OtherBCBSTX
TX215365202Medicaid
TX215365204Medicaid
TX215365203Medicaid
TX215365203Medicaid
TX215365202Medicaid
TX8CU134OtherBCBSTX
TXP01040737Medicare PIN
TXTXB109105Medicare PIN