=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942514310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN MEREDITH, AU.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2010
-----------------------------------------------------
Last Update Date | 07/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 STEWART RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48162-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-243-5020
-----------------------------------------------------
Fax | 734-457-1970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 STEWART RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48162-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-243-5020
-----------------------------------------------------
Fax | 734-457-1970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF AUDIOLOGY/OWNER
-----------------------------------------------------
Name | DR. RYAN L MEREDITH
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 734-243-5020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 1601000432
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------