MEDICARE: BDG OF IN, 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1689127946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BDG OF IN, INC

Provider Business Mailing Address
First Line	:	120 E MARKET ST STE 1223
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3250
Country	:	US
Telephone Number	:	888-964-5428
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E MARKET ST STE 1223
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3250
Country	:	US
Telephone Number	:	888-964-5428
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIEL RAGER
Credential	:
Telephone Number	:	888-964-5428

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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