MEDICARE: DR. JAMES THEROLD MEREDITH JR. M.D.

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	207Q00000X	Family Medicine Physician	C5727	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	080077472	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13346000000	OTHER	AR	QUALCHOICE
2	P01915	OTHER	AR	NOVASYS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	080077472	OTHER	AR	TRICARE
6	4032439	OTHER	AR	AETNA
8	172348500	OTHER	AR	US DEPT OF LABOR WC

General Provider Information

NPI Number	:	1639173420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THEROLD MEREDITH JR. M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/27/2023

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Directions to “ DR. JAMES THEROLD MEREDITH JR. M.D.” Practice Location

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