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NPI Code Detail

MEDICARE: SAMUEL GRANT MEYERS II P.A.-C

MEDICARE: SAMUEL GRANT MEYERS II P.A.-C
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
1363A00000XPhysician Assistant104018NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21306806179OTHERNCCHAMPUS

General Provider Information

NPI Number : 1306806179
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL GRANT MEYERS II P.A.-C
Provider Business Mailing Address
First Line : 3787 SHIPYARD BLVD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6148
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-332-3833
Provider Business Practice Location Address
First Line : 3787 SHIPYARD BLVD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6148
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-332-3833
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2006
Last Update Date : 10/01/2014

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