MEDICARE: MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	3953	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	744032	OTHER		UCCI
2	02601	OTHER	NC	BCBS GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326105933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

Provider Business Mailing Address
First Line	:	46 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3217
Country	:	US
Telephone Number	:	910-353-3535
Fax Number	:	910-353-9754

Provider Business Practice Location Address
First Line	:	46 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3217
Country	:	US
Telephone Number	:	910-353-3535
Fax Number	:	910-353-3535

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JOHN THOMAS MEADOWS
Credential	:
Telephone Number	:	910-353-3535

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/29/2010

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