Active NPI
Julie A Meehan, P.T.A.
- Skilled Nursing Facility
- Antigo, WI
National Provider Identifier
1679747877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1292-019
- Practice address
- 729 Park St
Antigo, WI 54409-2745 - Phone
- (715) 362-5583
- NPI assigned
- Apr 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1292-019 | WI | Primary |
Addresses
Primary practice location
729 Park St
Antigo, WI 54409-2745
Mailing address
729 Park St
Antigo, WI 54409-2745
Phone (715) 362-5583
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40480500 | Medicaid | WI |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1292-019 | WI | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208390400000",
"number": "1679747877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "729 PARK ST",
"city": "ANTIGO",
"state": "WI",
"postal_code": "544092745",
"telephone_number": "715-362-5583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "729 PARK ST",
"city": "ANTIGO",
"state": "WI",
"postal_code": "544092745",
"telephone_number": "715-362-5583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEEHAN",
"first_name": "JULIE",
"middle_name": "A",
"credential": "P.T.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-17",
"last_updated": "2008-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WI",
"license": "1292-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40480500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Antigo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.