MEDICARE: PATRICK J. BYRNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101030768	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134127277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J. BYRNE MD

Provider Business Mailing Address
First Line	:	801 JACKSON ST
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-5002
Country	:	US
Telephone Number	:	912-293-1279
Fax Number	:	912-538-7070

Provider Business Practice Location Address
First Line	:	ONE MEADOWS PARKWAY
Second Line	:	MEADOWS REGIONAL MEDICAL CENTER
City	:	VIDALIA
State	:	GA
Zip	:	30474
Country	:	US
Telephone Number	:	912-538-7777
Fax Number	:	912-538-7070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/19/2012

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