Provider Demographics
NPI:1972166809
Name:MERIDIAN IOP PLC
Entity type:Organization
Organization Name:MERIDIAN IOP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:GUARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:802-489-7235
Mailing Address - Street 1:462 HEGEMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3187
Mailing Address - Country:US
Mailing Address - Phone:802-489-7235
Mailing Address - Fax:802-497-1321
Practice Address - Street 1:462 HEGEMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3187
Practice Address - Country:US
Practice Address - Phone:802-489-7235
Practice Address - Fax:802-497-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health