Provider Demographics
NPI:1518499870
Name:MERIDIAN INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:MERIDIAN INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANITA
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-518-6990
Mailing Address - Street 1:3715 PRYTANIA ST
Mailing Address - Street 2:500
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3761
Mailing Address - Country:US
Mailing Address - Phone:504-518-6990
Mailing Address - Fax:504-518-6996
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:500
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-518-6990
Practice Address - Fax:504-518-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty