Provider Demographics
NPI:1427176577
Name:SAMANTHA MEEKS FAMILY PRACTICE
Entity type:Organization
Organization Name:SAMANTHA MEEKS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDIT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINESALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-521-0808
Mailing Address - Street 1:3221 S MEMORIAL DR
Mailing Address - Street 2:B
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1123
Mailing Address - Country:US
Mailing Address - Phone:765-521-0808
Mailing Address - Fax:
Practice Address - Street 1:3221 S MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1123
Practice Address - Country:US
Practice Address - Phone:765-521-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty