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General NPI Number Information
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NPI Number | 1255770236
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Entity Type | Organization
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Legal Business Name | MERIDIAN MEDICAL HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 06/23/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 3737 NORTH MERIDIAN STREET SUITE 410
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4374
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Country | US
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Telephone | 317-923-2444
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Fax | 317-923-8758
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Provider Business Mailing Address
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Address Line | 3737 NORTH MERIDIAN STREET SUITE 410
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4374
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Country | US
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Telephone | 317-923-2444
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Fax | 317-923-8758
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ANTOINE L TEVIS
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Credential |
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Telephone | 317-923-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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