MEDICARE: SERVICE ABOVE SELF, LLC

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	302F00000X	Exclusive Provider Organization

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

General Provider Information

NPI Number	:	1427061407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICE ABOVE SELF, LLC

Provider Business Mailing Address
First Line	:	3919 MEADOWS DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3113
Country	:	US
Telephone Number	:	317-541-1836
Fax Number	:	317-541-1858

Provider Business Practice Location Address
First Line	:	3919 MEADOWS DR
Second Line	:	BOX 421441
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3113
Country	:	US
Telephone Number	:	317-541-1836
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AUSTIN O NWAKA
Credential	:	CEO
Telephone Number	:	317-541-1836

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/30/2008

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