MEDICARE: MERIDIAN PEDIATRICS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1801919204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN PEDIATRICS

Provider Business Mailing Address
First Line	:	3653 N LOCUST GROVE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5924
Country	:	US
Telephone Number	:	208-338-5437
Fax Number	:	208-939-9811

Provider Business Practice Location Address
First Line	:	3653 N LOCUST GROVE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5924
Country	:	US
Telephone Number	:	208-338-5437
Fax Number	:	208-939-9811

Authorized Official
Title or Position	:	CLINIC OPERATIONS MANAGER
Name	:	CYNTHIA K BARINSKY
Credential	:
Telephone Number	:	208-338-5437

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/05/2009

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Directions to “MERIDIAN PEDIATRICS ” Practice Location

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