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General NPI Number Information
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NPI Number | 1811215460
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Entity Type | Organization
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Legal Business Name | MERIDIAN FAMILY MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 3333 BAYSHORE BLVD SUITE 250
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City | PASADENA
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State | TX
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Zip | 77504-1961
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Country | US
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Telephone | 914-400-4779
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Fax | 713-344-0738
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Provider Business Mailing Address
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Address Line | 3333 BAYSHORE BLVD 250
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City | PASADENA
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State | TX
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Zip | 77504-1952
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Country | US
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Telephone | 914-400-4779
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Fax |
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Authorized Official
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Title or Position | MEMBER/FNP
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Name | STEPHANIE BADU
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Credential | FNP
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Telephone | 914-400-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 735840
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 735840
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 735840
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License Number State | TX
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