MEDICARE: MERIDIAN CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	POD209	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6319270001	OTHER	OK	CIGNA GOVERNMENT

General Provider Information

NPI Number	:	1174767933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN CLINIC, INC

Provider Business Mailing Address
First Line	:	2201 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2629
Country	:	US
Telephone Number	:	405-943-9820
Fax Number	:	405-947-6908

Provider Business Practice Location Address
First Line	:	2201 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2629
Country	:	US
Telephone Number	:	405-943-9820
Fax Number	:	405-947-6908

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER QUOC LE
Credential	:	D.P.M
Telephone Number	:	405-943-9820

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/29/2010

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Directions to “MERIDIAN CLINIC, INC ” Practice Location

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