NPIMap

Organization Active NPI

Meadville Medical Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Meadville, PA
National Provider Identifier
1790477586
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MEADVILLE MEDICAL CENTER
Practice address
765 Liberty St Ste 307a
Meadville, PA 16335-2566
Phone
(814) 373-4270
Fax
(814) 373-4273
NPI assigned
May 22, 2023
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Authorized official

Name
Cory Frank Jackson
Title
Controller
Phone
(814) 333-5766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X Primary

Addresses

Primary practice location

765 Liberty St Ste 307a
Meadville, PA 16335-2566

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 373-4270

Other names 1

  • Meadville Endocrinology Other name

National Provider Directory

National Provider Directory
Tax ID family
Echocardiology Meadvill12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1790477586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-373-4270",
            "fax_number": "814-373-4273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 LIBERTY ST STE 307A",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352566",
            "telephone_number": "814-373-4270",
            "fax_number": "814-373-4273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADVILLE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "814-333-5766"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadville Endocrinology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.