| Meridian Gap Closure LLC | |
|
3524 N Meridian St Indianapolis IN 46208-4486 | |
| (317) 925-0653 | |
| Not Available |
| Full Name | Meridian Gap Closure LLC |
|---|---|
| Speciality | General Practice |
| Location | 3524 N Meridian St, Indianapolis, Indiana |
| Authorized Official Name and Position | Else Cole (CEO) |
| Authorized Official Contact | 3174967137 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Gap Closure LLC 3524 N Meridian St Indianapolis IN 46208-4486 | Meridian Gap Closure LLC 3524 N Meridian St Indianapolis IN 46208-4486 Ph: (317) 925-0653 |
| NPI Number | 1932981313 |
|---|---|
| Provider Enumeration Date | 10/19/2023 |
| Last Update Date | 03/03/2025 |
| Certification Date | 03/03/2025 |
| Medicare PECOS PAC ID | 2668814922 |
|---|---|
| Medicare Enrollment ID | O20240531002135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932981313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| 261QR0200X | Clinic/center - Radiology | () | Secondary |
| 261QR0208X | Clinic/center - Radiology, Mobile | () | Secondary |
| Provider Name | Robert E Mehl |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952340754 PECOS PAC ID: 2769440627 Enrollment ID: I20041222000688 |
| Provider Name | Michael T Gilpatrick |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1659333276 PECOS PAC ID: 3971542598 Enrollment ID: I20050503000203 |
| Provider Name | Amanda Laird |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770190456 PECOS PAC ID: 2668892993 Enrollment ID: I20201117001154 |
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