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General NPI Number Information
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NPI Number | 1275700601
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Entity Type | Organization
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Legal Business Name | MERIDIAN BEHAVIORAL HEALTHCARE
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 173 SE BAYA DR
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City | LAKE CITY
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State | FL
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Zip | 32025-5982
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Country | US
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Telephone | 386-755-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 173 SE BAYA DR
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City | LAKE CITY
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State | FL
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Zip | 32025-5982
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Country | US
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Telephone | 386-755-0337
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | HEATHER RUPERT
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Credential |
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Telephone | 352-374-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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