Organization
MERIDIAN HEALTH SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK SHAFER (C.F.O.)
(765) 288-1928
Entity
Organization
Contact information
Practice address
2300 CHESTER BLVD, RICHMOND, IN 47374-1221
(765) 288-1928
(765) 966-5750
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 966-5750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151931
—
IN
Enumeration date
09/18/2014
Last updated
07/20/2016
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