Healthcare Provider Details

I. General information

NPI: 1457980567
Provider Name (Legal Business Name): MEIER CLINICS OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 2ND AVE SUITE 201
KETCHUM ID
83340
US

IV. Provider business mailing address

2100 MANCHESTER RD STE 1510
WHEATON IL
60187-4561
US

V. Phone/Fax

Practice location:
  • Phone: 425-487-1005
  • Fax:
Mailing address:
  • Phone: 630-653-1717
  • Fax: 630-344-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BREE WEISS
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 630-653-1717