Provider Demographics
NPI:1760754428
Name:MERIDIAN FAMILY FOOT AND ANKLE CLINIC PLLC
Entity Type:Organization
Organization Name:MERIDIAN FAMILY FOOT AND ANKLE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORSYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-6152
Mailing Address - Street 1:13301 N. MERIDIAN
Mailing Address - Street 2:SUITE 701
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8357
Mailing Address - Country:US
Mailing Address - Phone:405-751-6152
Mailing Address - Fax:405-752-5158
Practice Address - Street 1:13301 N. MERIDIAN
Practice Address - Street 2:SUITE 701
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73120-8357
Practice Address - Country:US
Practice Address - Phone:405-751-6152
Practice Address - Fax:405-752-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK250213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty