Provider Demographics
NPI:1215533807
Name:MERIDIAN HEALTH PARTNERS PLLC
Entity Type:Organization
Organization Name:MERIDIAN HEALTH PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-564-2510
Mailing Address - Street 1:PO BOX 679676
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-9676
Mailing Address - Country:US
Mailing Address - Phone:512-515-0065
Mailing Address - Fax:
Practice Address - Street 1:14550 W STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-5792
Practice Address - Country:US
Practice Address - Phone:512-515-0065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty