MEDICARE: MERIDIAN ORTHOPAEDIC CLINIC, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1528136330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN ORTHOPAEDIC CLINIC, PA

Provider Business Mailing Address
First Line	:	PO BOX 5378
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-5378
Country	:	US
Telephone Number	:	601-693-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 15TH ST 4TH FL NORTH
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301
Country	:	US
Telephone Number	:	601-693-6663
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES GREEN
Credential	:	MD
Telephone Number	:	601-693-6663

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	02/07/2013

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