Active NPI
Kenneth R Meacham, M.D.
- Urology Physician
- Russellville, AR
National Provider Identifier
1407801707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- C4297
- Practice address
- 101 Skyline Dr
Russellville, AR 72801-3363 - Phone
- (479) 498-6583
- Fax
- (479) 498-6585
- NPI assigned
- May 24, 2006
- Last updated
- May 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | C4297 | AR | Primary |
Addresses
Primary practice location
101 Skyline Dr
Russellville, AR 72801-3363
Mailing address
101 Skyline Dr
Russellville, AR 72801-3363
Phone (479) 498-6583
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106516001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4297 | AR | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Marys Physician Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Cardiology Associates of North Central Arkansas
- Interventional Cardiology Physician
- Russellville, AR
- NPI 1720356207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1407801707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 SKYLINE DR",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728013363",
"telephone_number": "479-498-6583",
"fax_number": "479-498-6585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SKYLINE DR",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728013363",
"telephone_number": "479-498-6583",
"fax_number": "479-498-6585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEACHAM",
"first_name": "KENNETH",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-24",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "AR",
"license": "C4297",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106516001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.