MEDICARE: THE MEDICAL COLLECTION

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1447832183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDICAL COLLECTION

Provider Business Mailing Address
First Line	:	4556 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-3835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4556 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-3835
Country	:	US
Telephone Number	:	317-759-7979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RICKI LACY
Credential	:
Telephone Number	:	317-759-7979

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	06/02/2022

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Directions to “THE MEDICAL COLLECTION ” Practice Location

Language	Start Address	Practice Location

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