Healthcare Provider Details

I. General information

NPI: 1568995025
Provider Name (Legal Business Name): JOSHUA SIMON MEREDITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVENUE, MED PARK 2 SUITE 105
PADUCAH KY
42003
US

IV. Provider business mailing address

606 SHELRICH CT
CINCINNATI OH
45247
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-4802
  • Fax: 270-415-4835
Mailing address:
  • Phone: 270-415-4802
  • Fax: 270-415-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number62099
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: