# MERIDIAN ANESTHESIOLOGY GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639181019
- **Authorized official:** DON LARKIN KENNEDY (PRESIDENT)
- **Authorized official phone:** (601) 703-9614

## Contact information

- **Practice address:** 1200 16TH AVE, MERIDIAN, MS 39301-4209
- **Practice address phone:** (601) 485-6325
- **Practice address fax:** (601) 485-3061
- **Mailing address:** 1200 16TH AVE, MERIDIAN, MS 39301-4209
- **Mailing address phone:** (601) 485-6325
- **Mailing address fax:** (601) 485-3061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 08/13/2006
- **Last updated:** 08/31/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09015692 | — | MS |
| 01 | — | CB3237 | MEDICARE RAILROAD | GA |