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Organization
MERIDIAN WEIGHT MANAGEMENT CENTER
Active
Organization
MERIDIAN WEIGHT MANAGEMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID E BONNER RN (VICE-PRESIDENT)
(601) 696-6736
Entity
Organization
Contact information
Practice address
1715 23RD AVE, MERIDIAN, MS 39301-3104
(601) 696-6736
(601) 696-6778
Mailing address
1715 23RD AVE, MERIDIAN, MS 39301-3104
(601) 696-6736
(601) 696-6778
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
17693
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00755091
—
MS
05
—
009933895
—
AL
01
—
73012009
BCBS AL
AL
01
—
930002774
MEDICARE ID-TYPE UNSPECIFIED
MS
01
—
P00071956
RAILROAD MEDICARE
MS
Enumeration date
10/24/2013
Last updated
10/24/2013
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