MEDICARE: MERIDIAN FAMILY CARE, 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
1	207Q00000X	Family Medicine Physician	MD11593	OR

General Provider Information

NPI Number	:	1932100526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN FAMILY CARE, LLC

Provider Business Mailing Address
First Line	:	19250 SW 65TH AVE
Second Line	:	STE 265
City	:	TUALATIN
State	:	OR
Zip	:	97062-7452
Country	:	US
Telephone Number	:	503-692-3110
Fax Number	:	503-612-6835

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE
Second Line	:	STE 265
City	:	TUALATIN
State	:	OR
Zip	:	97062-7452
Country	:	US
Telephone Number	:	503-692-3110
Fax Number	:	503-612-6835

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANKLIN S. WEINGARTEN
Credential	:	M.D., PH.D.
Telephone Number	:	503-692-3110

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	01/18/2010

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