Healthcare Provider Details

I. General information

NPI: 1295773398
Provider Name (Legal Business Name): MERIDIAN FOOT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN BLDG 700 SUITE 701
OKLA CITY OK
73120-9369
US

IV. Provider business mailing address

13301 N MERIDIAN BLDG 700 SUITE 701
OKLA CITY OK
73120-9369
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-6152
  • Fax: 405-752-5158
Mailing address:
  • Phone: 405-751-6152
  • Fax: 405-752-5158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number113
License Number StateOK

VIII. Authorized Official

Name: DR. RONALD WAYNE HINES
Title or Position: OWNER OF CORPORATION
Credential: DPM
Phone: 405-751-6152