Provider Demographics
NPI:1538414743
Name:MERIDIAN MEDICAL RESOURCES, INC.
Entity type:Organization
Organization Name:MERIDIAN MEDICAL RESOURCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-381-2464
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92406-2040
Mailing Address - Country:US
Mailing Address - Phone:800-320-4259
Mailing Address - Fax:800-320-4287
Practice Address - Street 1:740 W MILL ST
Practice Address - Street 2:UNITS G & H
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3359
Practice Address - Country:US
Practice Address - Phone:800-320-4259
Practice Address - Fax:800-320-4287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HOLDINGS INTL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56288332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies