Healthcare Provider Details

I. General information

NPI: 1033167499
Provider Name (Legal Business Name): MERIDIAN MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N RONALD REAGAN PKWY SUITE 347
AVON IN
46123
US

IV. Provider business mailing address

1801 N SENATE BLVD SUITE 400
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-2111
  • Fax: 317-217-2110
Mailing address:
  • Phone: 317-962-6300
  • Fax: 317-962-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number050037961
License Number StateIN

VIII. Authorized Official

Name: ROBIN A WALTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-962-5870