MEDICARE: MERIDIAN FOOT 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	213E00000X	Podiatrist	113	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023011616	OTHER	OK	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1295773398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN FOOT CLINIC INC

Provider Business Mailing Address
First Line	:	13301 N MERIDIAN
Second Line	:	BLDG 700 SUITE 701
City	:	OKLA CITY
State	:	OK
Zip	:	73120-9369
Country	:	US
Telephone Number	:	405-751-6152
Fax Number	:	405-752-5158

Provider Business Practice Location Address
First Line	:	13301 N MERIDIAN
Second Line	:	BLDG 700 SUITE 701
City	:	OKLA CITY
State	:	OK
Zip	:	73120-9369
Country	:	US
Telephone Number	:	405-751-6152
Fax Number	:	405-752-5158

Authorized Official
Title or Position	:	OWNER OF CORPORATION
Name	:	DR. RONALD WAYNE HINES
Credential	:	DPM
Telephone Number	:	405-751-6152

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/20/2008

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Directions to “MERIDIAN FOOT CLINIC INC ” Practice Location

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