Provider Demographics
NPI:1871171959
Name:MERIBAH CLINIC LLC
Entity type:Organization
Organization Name:MERIBAH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEYIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-332-8969
Mailing Address - Street 1:1005 BROOKSIDE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9023
Mailing Address - Country:US
Mailing Address - Phone:832-443-8771
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD STE 240
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:832-443-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty