MEDICARE: MERIDIAN WELLNESS CENTER INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689977282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	3949 BRAXTON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3949 BRAXTON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:	713-778-9300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GODWIN ANEKWE
Credential	:
Telephone Number	:	713-778-9300

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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