Provider Demographics
NPI:1245443423
Name:MERIDIAN GYNECOLOGICAL CENTER
Entity type:Organization
Organization Name:MERIDIAN GYNECOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:VON STEIN, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-831-9469
Mailing Address - Street 1:1205 HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1737
Mailing Address - Country:US
Mailing Address - Phone:317-831-9439
Mailing Address - Fax:317-834-5928
Practice Address - Street 1:1205 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1737
Practice Address - Country:US
Practice Address - Phone:317-831-9439
Practice Address - Fax:317-834-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040116A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC13913Medicare PIN
IN277420Medicare PIN