Basic Information
| Provider Information | |||||||||
| NPI: | 1922185487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHILIP W. MEYER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4905 S 107TH AVE | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681271965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023939459 | ||||||||
| FaxNumber: | 4023979895 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 RIDGE ST | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515034643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123220253 | ||||||||
| FaxNumber: | 7123225273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEYER | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7123220253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 20597 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 14027 | 01 | IA | BCBS IA PROVIDER # | OTHER | 0140277 | 05 | IA | MEDICAID |