Meadow Lake Surgery Center Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

M8189 Issued in ID

Legal business name

MEADOW LAKE SURGERY CENTER INC

Practice address

3630 E Louise Dr
Suite 200
Meridian, ID 83642-7975

Phone

(208) 377-9515

Fax

(208) 377-9517

NPI assigned

Oct 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark D Wigod, M.D.

Title

M.D.

Phone

(208) 377-9515

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Listed as

Meadow Lake Surgery Center IncCCN 13C0001063

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379289600000",
    "number": "1740479476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 E LOUISE DR",
            "address_2": "SUITE 200",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427975",
            "telephone_number": "208-377-9515",
            "fax_number": "208-377-9517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 E LOUISE DR",
            "address_2": "SUITE 200",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427975",
            "telephone_number": "208-377-9515",
            "fax_number": "208-377-9517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW LAKE SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2013-09-16",
        "status": "A",
        "authorized_official_last_name": "WIGOD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "208-377-9515",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ID",
            "license": "M8189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lon Chad McRae, DMD
• Kevin Bernard McSweeney, O.D.
• Judson Robert Mead, PA
• Sandra D Meador, ATC, LAT
• Lawrence Wayne Meadors, D.M.D.
• Teri Ann Meadows, DNP
• Christine Measham, M.D.
• Med Way Medical, Inc
• Medical Solutions Health and Wellness LLC
• Medical Staffing Network Healthcare, LLC

• Ambulatory Surgical Clinic/Center in Meridian, ID
• Providers in Meridian, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.