Healthcare Provider Details

I. General information

NPI: 1720679129
Provider Name (Legal Business Name): MERIDAN MEDICAL & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N MESA ST STE B
EL PASO TX
79902-3309
US

IV. Provider business mailing address

1900 N MESA ST STE B
EL PASO TX
79902-3309
US

V. Phone/Fax

Practice location:
  • Phone: 915-200-3788
  • Fax: 915-200-3914
Mailing address:
  • Phone: 915-200-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TANEKA WILBORN
Title or Position: OWNER
Credential: ANP-BC
Phone: 915-200-3788