Provider Demographics
NPI:1801084421
Name:MATTHEW W MEIER LLC
Entity type:Organization
Organization Name:MATTHEW W MEIER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-294-5757
Mailing Address - Street 1:1002 PERUQUE CROSSING COURT
Mailing Address - Street 2:SUITE102
Mailing Address - City:OFALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5757
Mailing Address - Fax:636-294-5742
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:SUITE 102
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5757
Practice Address - Fax:636-294-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9J58261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013911Medicare PIN