Provider Demographics
NPI:1710924089
Name:NORTH MERIDIAN STREET SURGICENTER ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTH MERIDIAN STREET SURGICENTER ASSOCIATES LLC
Other - Org Name:NORTH MERIDIAN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-574-5400
Mailing Address - Street 1:13225 N. MERIDIAN ST.
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-574-5400
Mailing Address - Fax:317-575-0173
Practice Address - Street 1:13225 N. MERIDIAN ST.
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-574-5400
Practice Address - Fax:317-575-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
IN15-007125-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10038940Medicaid
ZJ0980Medicare PIN