MEDICARE: MRS. SUSAN REINE MEEKS C.P.M - TN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	CPM0000000013	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3149014	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134266539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN REINE MEEKS C.P.M - TN

Provider Business Mailing Address
First Line	:	5566 BIG EAST FORK RD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-9482
Country	:	US
Telephone Number	:	615-794-0872
Fax Number	:	615-591-5473

Provider Business Practice Location Address
First Line	:	5566 BIG EAST FORK RD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-9482
Country	:	US
Telephone Number	:	615-794-0872
Fax Number	:	615-591-5473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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