Organization
MERIDIAN HEALTH SERVICES CORP
Active
Organization
MERIDIAN HEALTH SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK SHAFER (VICE PRESIDENT OF FINANCE)
(765) 288-1928
Entity
Organization
Contact information
Practice address
100 N TILLOTSON AVE, MUNCIE, IN 47304-3987
(765) 288-1928
(765) 288-8775
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 288-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
422-0-CMHC
IN
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D1068720
CLIA
IN
Enumeration date
04/07/2010
Last updated
07/20/2016
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