Provider Demographics
NPI:1164420667
Name:MERIDIAN HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:MERIDIAN HOSPITALS CORPORATION
Other - Org Name:OCEAN MEDICAL CENTER- RENAL DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENOIR VP, FINANCE & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-7520
Mailing Address - Street 1:2020 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6109
Mailing Address - Country:US
Mailing Address - Phone:732-897-7130
Mailing Address - Fax:
Practice Address - Street 1:1640 ROUTE 88
Practice Address - Street 2:BRICK MEDICAL ARTS BUILDING SUITE 102
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3036
Practice Address - Country:US
Practice Address - Phone:732-206-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN HOSPITALS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-08
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3674908Medicaid
NJ3674908Medicaid