Provider Demographics
NPI:1104385152
Name:MERIDIAN PREFERRED NETWORK, LLC
Entity Type:Organization
Organization Name:MERIDIAN PREFERRED NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOESLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-679-3761
Mailing Address - Street 1:2900 N QUINLAN PARK RD
Mailing Address - Street 2:STE 240-202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732
Mailing Address - Country:US
Mailing Address - Phone:877-875-9588
Mailing Address - Fax:
Practice Address - Street 1:11512 TIBEE DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726
Practice Address - Country:US
Practice Address - Phone:877-875-9588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies