Provider Demographics
NPI:1548556764
Name:MERIDIAN FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:MERIDIAN FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-284-8071
Mailing Address - Street 1:5252 N MERIDIAN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2136
Mailing Address - Country:US
Mailing Address - Phone:405-601-3330
Mailing Address - Fax:
Practice Address - Street 1:5252 N MERIDIAN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2178
Practice Address - Country:US
Practice Address - Phone:614-284-8071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty