MEDICARE: W3IG SWAP 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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1710538897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W3IG SWAP INC.

Provider Business Mailing Address
First Line	:	6252 BISHOP POND LANE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8319 MICHIGAN RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3635
Country	:	US
Telephone Number	:	866-944-7927
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAQUITA BARNES
Credential	:	CERT.HAIR LOSS SPEC.
Telephone Number	:	866-944-7927

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/20/2019

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