Healthcare Provider Details

I. General information

NPI: 1932230224
Provider Name (Legal Business Name): RICHARD I MERIDETH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 E 3900 S A-200
SALT LAKE CITY UT
84124-1215
US

IV. Provider business mailing address

11754 S GRANDVILLE AVE #105
SOUTH JORDAN UT
84095-5077
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-2300
  • Fax:
Mailing address:
  • Phone: 801-369-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: