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General NPI Number Information
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NPI Number | 1962682468
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Entity Type | Organization
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Legal Business Name | MERIDIAN IMAGING, PA
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 1102 CONSTITUTION AVE FIRST FLOOR
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City | MERIDIAN
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State | MS
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Zip | 39301-4001
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Country | US
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Telephone | 601-693-5843
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Fax | 601-693-0173
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Provider Business Mailing Address
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Address Line | PO BOX 5653
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City | MERIDIAN
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State | MS
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Zip | 39302-5653
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Country | US
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Telephone | 601-693-5843
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Fax | 601-693-0173
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL STACY THAGGARD
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Credential | M.D.
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Telephone | 601-693-5843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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