Healthcare Provider Details

I. General information

NPI: 1124324678
Provider Name (Legal Business Name): JOHN C MEADOWS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCGREGOR ST
MANCHESTER NH
03102-3730
US

IV. Provider business mailing address

5855 BREMO RD SUITE 100
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3545
  • Fax:
Mailing address:
  • Phone: 804-288-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169171
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number090850-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: