Provider Demographics
NPI:1255523056
Name:MERIDIA MEDICAL GROUP LLC
Entity type:Organization
Organization Name:MERIDIA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-761-3300
Mailing Address - Street 1:275 SPRINGSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4548
Mailing Address - Country:US
Mailing Address - Phone:234-466-4083
Mailing Address - Fax:866-211-7728
Practice Address - Street 1:2999 MCMACKIN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2330
Practice Address - Country:US
Practice Address - Phone:440-428-1111
Practice Address - Fax:440-428-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2746461Medicaid
OH2746461Medicaid