MEDICARE: INTERIM HEALTHCARE OF SE INDIANA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	05-003257-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000346938	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1083682728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HEALTHCARE OF SE INDIANA, INC.

Provider Business Mailing Address
First Line	:	3200 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3166
Country	:	US
Telephone Number	:	812-799-1846
Fax Number	:	812-799-1848

Provider Business Practice Location Address
First Line	:	3200 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3166
Country	:	US
Telephone Number	:	812-799-1846
Fax Number	:	812-799-1848

Authorized Official
Title or Position	:	CEO
Name	:	MR. THOMAS J DIMARCO
Credential	:
Telephone Number	:	614-436-9404

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/16/2024

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