Healthcare Provider Details

I. General information

NPI: 1174767933
Provider Name (Legal Business Name): MERIDIAN CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N MERIDIAN AVE
OKLAHOMA CITY OK
73107-2629
US

IV. Provider business mailing address

2201 N MERIDIAN AVE
OKLAHOMA CITY OK
73107-2629
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-9820
  • Fax: 405-947-6908
Mailing address:
  • Phone: 405-943-9820
  • Fax: 405-947-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD209
License Number StateOK

VIII. Authorized Official

Name: DR. PETER QUOC LE
Title or Position: OWNER
Credential: D.P.M
Phone: 405-943-9820