Provider Demographics
NPI:1316905599
Name:MERIDIAN MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:MERIDIAN MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-633-8090
Mailing Address - Street 1:7856 WESTSIDE PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8541
Mailing Address - Country:US
Mailing Address - Phone:261-633-8090
Mailing Address - Fax:251-633-6941
Practice Address - Street 1:500 17TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3531
Practice Address - Country:US
Practice Address - Phone:601-693-5312
Practice Address - Fax:601-693-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04826811Medicaid
MS04826811Medicaid
MS5115010001Medicare ID - Type UnspecifiedPROVIDER