MEDICARE: JAMES T. MEREDITH JR MD PA

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	305R00000X	Preferred Provider Organization	MC0977	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DG5130	OTHER	SC	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1164491767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES T. MEREDITH JR MD PA

Provider Business Mailing Address
First Line	:	921 HOLIDAY DR
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-633-4711
Fax Number	:	870-633-4850

Provider Business Practice Location Address
First Line	:	921 HOLIDAY DR
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-633-4711
Fax Number	:	870-633-4850

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES THEROLD MEREDITH JR.
Credential	:	MD
Telephone Number	:	870-633-4711

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/24/2020

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