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NPI Code Detail

MEDICARE: TIM J MEYER ST

MEDICARE: TIM J MEYER ST
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
1235Z00000XSpeech-Language PathologistIL

General Provider Information

NPI Number : 1144432063
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIM J MEYER ST
Provider Business Mailing Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-4000
Fax Number : 618-588-4800
Provider Business Practice Location Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-4000
Fax Number : 618-588-4800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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Directions to “ TIM J MEYER ST” Practice Location

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