MEDICARE: MERIDIAN HEALTH POST ACUTE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
2	363AM0700X	Medical Physician Assistant
3	363L00000X	Nurse Practitioner
4	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1609731819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN HEALTH POST ACUTE PLLC

Provider Business Mailing Address
First Line	:	950 W BETHANY DR STE 570
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 W BETHANY DR STE 570
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3845
Country	:	US
Telephone Number	:	844-941-3087
Fax Number	:	844-593-1570

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	GRADY GOODWIN
Credential	:	MD
Telephone Number	:	214-564-2510

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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