=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548264476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERIDITH CHRISTINE YOCHIM PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 01/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 ECKHART AVE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46706-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-920-1014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8529 GREYHAWK DR
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46835-9683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-730-6885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------