Provider Demographics
NPI:1639440878
Name:MERIDIAN HOLDINGS, INC
Entity Type:Organization
Organization Name:MERIDIAN HOLDINGS, INC
Other - Org Name:MERIDIAN HEALTH SYSTEMS ACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-252-2784
Mailing Address - Street 1:4477 W 118TH ST
Mailing Address - Street 2:304
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2255
Mailing Address - Country:US
Mailing Address - Phone:323-252-2784
Mailing Address - Fax:310-693-8082
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:304
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:323-252-2784
Practice Address - Fax:310-693-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty