MEDICARE: ERIC D MEEKS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1164302949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC D MEEKS

Provider Business Mailing Address
First Line	:	3457 S 85TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-4617
Country	:	US
Telephone Number	:	414-931-1132
Fax Number	:	262-204-8121

Provider Business Practice Location Address
First Line	:	3457 S 85TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-4617
Country	:	US
Telephone Number	:	414-931-1132
Fax Number	:	262-204-8121

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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