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General NPI Number Information
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NPI Number | 1346489457
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CLINIC OF MERIDIAN
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 1430 HWY 19 N
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City | MERIDIAN
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State | MS
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Zip | 39307-5378
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Country | US
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Telephone | 601-282-5346
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Fax | 601-282-5347
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Provider Business Mailing Address
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Address Line | 1430 HWY 19 N
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City | MERIDIAN
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State | MS
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Zip | 39307-5378
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Country | US
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Telephone | 601-282-5346
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Fax | 601-282-5347
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PEDRO A MUNERA-CORDOBA
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Credential | M.D.
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Telephone | 601-282-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 17363
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License Number State | MS
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