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NPI Code Detail

MEDICARE: MERIDIA MEDICAL GROUP LLC

MEDICARE: MERIDIA MEDICAL GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34002884OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255523056
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERIDIA MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 275 SPRINGSIDE DR
Second Line : SUITE 100
City : AKRON
State : OH
Zip : 44333-4548
Country : US
Telephone Number : 234-466-4083
Fax Number : 866-211-7728
Provider Business Practice Location Address
First Line : 2999 MCMACKIN RD
Second Line :
City : MADISON
State : OH
Zip : 44057-2330
Country : US
Telephone Number : 440-428-1111
Fax Number : 440-428-0709
Authorized Official
Title or Position : V.P OF OPERATIONS
Name : MICHAEL O'CONNELL
Credential :
Telephone Number : 216-761-3300
Provider Enumeration Date : 08/15/2007
Last Update Date : 11/16/2007

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