Basic Information
| Provider Information | |||||||||
| NPI: | 1649755208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEA PRIMARY CARE PLUS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4204 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391833438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016197717 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4204 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391833438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016197717 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2018 | ||||||||
| LastUpdateDate: | 09/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | BUIE | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 6018987530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.