Provider Demographics
NPI:1750723102
Name:MSL MERIDIAN
Entity type:Organization
Organization Name:MSL MERIDIAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-523-7370
Mailing Address - Street 1:1015 N MAIN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76665-4632
Mailing Address - Country:US
Mailing Address - Phone:254-435-2357
Mailing Address - Fax:
Practice Address - Street 1:1015 N MAIN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665-4632
Practice Address - Country:US
Practice Address - Phone:254-435-2357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility