Provider Demographics
NPI:1619310042
Name:MERIDIAN PAIN GROUP
Entity Type:Organization
Organization Name:MERIDIAN PAIN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-550-3999
Mailing Address - Street 1:69 E GARNER RD
Mailing Address - Street 2:300
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7698
Mailing Address - Country:US
Mailing Address - Phone:317-550-3999
Mailing Address - Fax:888-588-4403
Practice Address - Street 1:69 E GARNER RD
Practice Address - Street 2:300
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7698
Practice Address - Country:US
Practice Address - Phone:317-550-3999
Practice Address - Fax:888-588-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027589A261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN50005219AOtherMEDLICAL CORPORATION