MEADOW LAKE SURGERY CENTER INC (NPI# 1740479476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740479476 |
| Entity Type | Organization |
| Organization Name | MEADOW LAKE SURGERY CENTER INC |
| Practice Address |
3630 E Louise Dr Suite 200 Meridian ID 83642-7975 |
| Practice Telephone | 2083779515 |
| Practice Fax Number | 2083779517 |
| Mailing Telephone | 2083779515 |
| Mailing Fax Number | 2083779517 |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2013-09-16 |
| Authorized Official Name | MARK D WIGOD (M.D.) |
| Authorized Official Telephone | 2083779515 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
M8189 | ID | Ambulatory Health Care Facilities |
| Street Address |
3630 E LOUISE DR SUITE 200 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-7975 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194285718 | Jt Anesthesia Services Pllp | Nurse Anesthetist, Certified Registered | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2019-03-20 |
| 1689914186 | Ep Services LLC | Nurse Anesthetist, Certified Registered | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2013-02-20 |
| 1508197666 | Chamagne Janae Eaton | Specialist/Technologist, Other | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2010-01-28 |
| 1275772667 | Rebecca D Shaw | Surgery | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2009-02-09 |
| 1871749408 | Jacqueline King | Clinic/Center | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2008-08-14 |
| 1679751770 | Mark D. Wigod, Md, Pa | Surgery | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2008-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235255605 | Eagle Eye Surgery and Laser Center LLC | Clinic/Center | 3090 E Gentry Way Ste 100, Meridian, ID 83642-3548 | 2007-03-21 |
| 1770598591 | Boise Center for Foot Surgery Pllc | Clinic/Center | 1828 S Millennium Way, Suite 100, Meridian, ID 83642-5036 | 2006-07-30 |
| 1063445542 | Total Pain Care LLC | Clinic/Center | 1001 14th Street, Meridian, MS 39301 | 2006-07-08 |
| 1790714525 | Plastic Surgery Center of Meridian, LLC | Clinic/Center | 5002 Hwy 30 North, Bldg. D, Meridian, MS 39301 | 2006-07-02 |
| 1083674196 | Vision Care Center of Idaho LLC | Clinic/Center | 3071 E Franklin Rd, Suite 101, Meridian, ID 83642-2376 | 2006-03-23 |
| 1184600736 | Meridian Surgery Center, LLC | Clinic/Center | 2100 13th St, Meridian, MS 39301-3428 | 2005-12-15 |
| 1912992900 | Boise Endoscopy Center, LLC | Clinic/Center | 2235 E Gala St, Meridian, ID 83642-7090 | 2005-09-15 |
| 1396069902 | Southern Idaho Surgery Center Pllc | Clinic/Center | 3235 N Towerbridge Way Ste 100, Meridian, ID 83646-5721 | 2010-03-25 |
| 1871749408 | Jacqueline King | Clinic/Center | 3630 E Louise Dr, Meridian, ID 83642-7975 | 2008-08-14 |
| 1780774745 | East Mississippi Endoscopy Center LLC | Clinic/Center | 1926 23rd Ave, Meridian, MS 39301-3107 | 2006-10-13 |
| Find all providers in MERIDIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.