Healthcare Provider Details

I. General information

NPI: 1831148527
Provider Name (Legal Business Name): MERIDIAN PLASTIC SURGERY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 106TH ST
INDIANAPOLIS IN
46290-1004
US

IV. Provider business mailing address

170 W 106TH ST
INDIANAPOLIS IN
46290-1004
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-0110
  • Fax: 317-846-5719
Mailing address:
  • Phone: 317-575-0110
  • Fax: 317-846-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number14-005406-1
License Number StateIN

VIII. Authorized Official

Name: STEPHEN W PERKINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-575-0110