Healthcare Provider Details

I. General information

NPI: 1447073382
Provider Name (Legal Business Name): MATTHEW CARMICHAEL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W JEFFERSON ST
FRANKLIN IN
46131-2765
US

IV. Provider business mailing address

2615 INDIANA AVE
COLUMBUS IN
47201-7211
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-3300
  • Fax:
Mailing address:
  • Phone: 812-569-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30009340A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: