MEDICARE: MOBILTEK MEDICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies	0115153918	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69000094A	OTHER	IN	INDIANA BOARD OF PHARMACY
2	000000351337	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336130608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILTEK MEDICAL INC.

Provider Business Mailing Address
First Line	:	675 NORTH U.S. 31
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184
Country	:	US
Telephone Number	:	317-535-2510
Fax Number	:	317-535-4783

Provider Business Practice Location Address
First Line	:	675 NORTH U.S. 31
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184
Country	:	US
Telephone Number	:	317-535-2510
Fax Number	:	317-535-4783

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JIM RAY HALL II
Credential	:
Telephone Number	:	317-535-2510

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	08/22/2020

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1376504506 — MRS. JANINE ANN SAUGSTAD CTRS
Practice Location Address:

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420 N US HIGHWAY 31
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Directions to “MOBILTEK MEDICAL INC. ” Practice Location

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