Provider Demographics
NPI:1154992170
Name:MERIDIAN INFECTIOUS DISEASE CONSULTANTS, PLLC
Entity type:Organization
Organization Name:MERIDIAN INFECTIOUS DISEASE CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CERES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-718-6648
Mailing Address - Street 1:2830 S. HULEN ST. #858
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1514
Mailing Address - Country:US
Mailing Address - Phone:817-718-6648
Mailing Address - Fax:
Practice Address - Street 1:6100 HARRIS PKWY STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4131
Practice Address - Country:US
Practice Address - Phone:817-841-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty