=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891467197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEIBEYER PSYCHIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2021
-----------------------------------------------------
Last Update Date | 10/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2145 UNIVERSITY PARK DR STE 370
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-3982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-292-0754
-----------------------------------------------------
Fax | 517-200-4358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 E JOLLY RD
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48910-6818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ZANE MEIBEYER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 517-292-0754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------