Provider Demographics
NPI:1073137147
Name:MERIDIAN IOM
Entity Type:Organization
Organization Name:MERIDIAN IOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:541-517-1206
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:INDIAN HILLS
Mailing Address - State:CO
Mailing Address - Zip Code:80454-0705
Mailing Address - Country:US
Mailing Address - Phone:541-517-1206
Mailing Address - Fax:
Practice Address - Street 1:21521 FALCON WING ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN HILLS
Practice Address - State:CO
Practice Address - Zip Code:80454-8045
Practice Address - Country:US
Practice Address - Phone:541-517-1206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty