Basic Information
| Provider Information | |||||||||
| NPI: | 1346454154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEADOWS | ||||||||
| FirstName: | ROCKFORD | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST STE B06 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568681 | ||||||||
| FaxNumber: | 7403537900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 E RING RD | ||||||||
| Address2: | |||||||||
| City: | IRONTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456389610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405349830 | ||||||||
| FaxNumber: | 7405349832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.092454 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000593194 | 01 | KY | ANTHEM BCBS | OTHER | 2865805 | 05 | OH | MEDICAID | 000000585221 | 01 | KY | ANTHEM BCBS | OTHER | 000000609822 | 01 | KY | ANTHEM BCBS | OTHER | 7100055940 | 05 | KY | MEDICAID | P00673293 | 01 | KY | RR MEDICARE | OTHER |