Basic Information
| Provider Information | |||||||||
| NPI: | 1598801243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEADE | ||||||||
| FirstName: | HERSHEL | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8 | ||||||||
| Address2: | 307 CHISUM STREET | ||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713680008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183894028 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 CHISUM STREET | ||||||||
| Address2: | |||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713680008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183894028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD 024332 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1574503 | 05 | LA | MEDICAID |