Provider Demographics
NPI:1629128418
Name:MERIDIAN PRIMARY CARE PC
Entity Type:Organization
Organization Name:MERIDIAN PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-349-6140
Mailing Address - Street 1:2270 JOLLY OAK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4528
Mailing Address - Country:US
Mailing Address - Phone:517-349-6140
Mailing Address - Fax:517-349-6216
Practice Address - Street 1:2270 JOLLY OAK RD
Practice Address - Street 2:SUITE1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4528
Practice Address - Country:US
Practice Address - Phone:517-349-6140
Practice Address - Fax:517-349-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP052522207Q00000X
MIKC064356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4186985Medicaid
MI4187015Medicaid
MIF96081Medicare UPIN
MI4187015Medicaid
MI0M98740Medicare PIN