Healthcare Provider Details

I. General information

NPI: 1477257889
Provider Name (Legal Business Name): MERIDIAN CORRECTIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 N MERIDIAN ST
INDIANAPOLIS IN
46208-4486
US

IV. Provider business mailing address

3524 N MERIDIAN ST
INDIANAPOLIS IN
46208-4486
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-0653
  • Fax: 317-854-7767
Mailing address:
  • Phone: 317-925-0653
  • Fax: 317-225-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. ELSE COLE
Title or Position: CEO
Credential:
Phone: 317-496-7137