| Organization Name: | MERIDIAN MEDICAL GROUP PC |
| NPI Number: | 1033167499 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN A WALTER (ADMINISTRATOR) |
| Mailing Address: | 1115 N Ronald Reagan Pkwy Suite 347 Avon |
| State: | IN US |
| Postal Code: | 46123 |
| Phone Number: | 3172172111 |
| Fax Number: | 3172172110 |
| NPI Enumeration Date: | 05/05/2006 |
| NPI Last Update Date: | 09/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 050037961 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |