MEDICARE: MERIDIAN REGIONAL DIAGNOSTICS GROUP LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1740941327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN REGIONAL DIAGNOSTICS GROUP LLC

Provider Business Mailing Address
First Line	:	1001 1ST AVE E
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-6024
Country	:	US
Telephone Number	:	205-266-9270
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 1ST AVE E
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-6024
Country	:	US
Telephone Number	:	205-266-9270
Fax Number	:	601-227-4927

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOHNNEY BELL
Credential	:
Telephone Number	:	205-266-9270

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	05/21/2026

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