Healthcare Provider Details

I. General information

NPI: 1932100526
Provider Name (Legal Business Name): MERIDIAN FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 265
TUALATIN OR
97062-7452
US

IV. Provider business mailing address

19250 SW 65TH AVE STE 265
TUALATIN OR
97062-7452
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-3110
  • Fax: 503-612-6835
Mailing address:
  • Phone: 503-692-3110
  • Fax: 503-612-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11593
License Number StateOR

VIII. Authorized Official

Name: DR. FRANKLIN S. WEINGARTEN
Title or Position: OWNER
Credential: M.D., PH.D.
Phone: 503-692-3110