Provider Demographics
NPI:1437514817
Name:MERIDIAN MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:MERIDIAN MEDICAL SERVICES INC
Other - Org Name:MERIDIAN LABORATORY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELSE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-925-0653
Mailing Address - Street 1:PO BOX 10779
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46853-0779
Mailing Address - Country:US
Mailing Address - Phone:888-522-2265
Mailing Address - Fax:
Practice Address - Street 1:3524 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4486
Practice Address - Country:US
Practice Address - Phone:317-925-0653
Practice Address - Fax:317-925-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15D2067414291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D2067414OtherCLIA