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General NPI Number Information
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NPI Number | 1427176577
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Entity Type | Organization
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Legal Business Name | SAMANTHA MEEKS FAMILY PRACTICE
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 3221 S MEMORIAL DR SUITE B
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City | NEW CASTLE
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State | IN
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Zip | 47362-1123
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Country | US
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Telephone | 765-521-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 S MEMORIAL DR B
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City | NEW CASTLE
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State | IN
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Zip | 47362-1123
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Country | US
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Telephone | 765-521-0808
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Fax |
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Authorized Official
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Title or Position | CREDIT MANAGER
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Name | TOREY RAINESALO
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Credential |
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Telephone | 765-521-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71000462
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License Number State | IN
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