Healthcare Provider Details

I. General information

NPI: 1528539590
Provider Name (Legal Business Name): MERIDIAN HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 NW 18TH ST., BLDG 416 STED D BLDG 416 STE D
RICHMOND IN
47374-2851
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-373-8704
  • Fax: 765-488-2609
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: GARY GATES
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 765-254-2685