MEDICARE: MERIDIAN BEHAVIORAL HEALTHCARE

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	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1275700601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	173 SE BAYA DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5982
Country	:	US
Telephone Number	:	386-755-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 SE BAYA DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5982
Country	:	US
Telephone Number	:	386-755-0337
Fax Number	:

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	HEATHER RUPERT
Credential	:
Telephone Number	:	352-374-5600

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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