Provider Demographics
NPI:1720679129
Name:MERIDAN MEDICAL & ASSOCIATES
Entity Type:Organization
Organization Name:MERIDAN MEDICAL & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBORN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:915-200-3788
Mailing Address - Street 1:1900 N MESA ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3309
Mailing Address - Country:US
Mailing Address - Phone:915-200-3788
Mailing Address - Fax:
Practice Address - Street 1:1900 N MESA ST STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3309
Practice Address - Country:US
Practice Address - Phone:915-200-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty