# MERIDIAN WEIGHT MANAGEMENT CENTER

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

## Provider details

- **NPI number:** 1952739229
- **Authorized official:** DAVID E BONNER RN (VICE-PRESIDENT)
- **Authorized official phone:** (601) 696-6736

## Contact information

- **Practice address:** 1715 23RD AVE, MERIDIAN, MS 39301-3104
- **Practice address phone:** (601) 696-6736
- **Practice address fax:** (601) 696-6778
- **Mailing address:** 1715 23RD AVE, MERIDIAN, MS 39301-3104
- **Mailing address phone:** (601) 696-6736
- **Mailing address fax:** (601) 696-6778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 17693 | MS | Yes |

## Other

- **Enumeration date:** 10/24/2013
- **Last updated:** 10/24/2013

## 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 |