Healthcare Provider Details

I. General information

NPI: 1225064793
Provider Name (Legal Business Name): MEDICAL SUPPLY PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 GRANT STREET
GARY IN
46404
US

IV. Provider business mailing address

PO BOX 2000
GARY IN
46409
US

V. Phone/Fax

Practice location:
  • Phone: 219-949-7587
  • Fax: 219-949-7860
Mailing address:
  • Phone: 219-949-7587
  • Fax: 219-949-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200293200A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier48001666A
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerWHOLESALE DRUG DIS REFER
# 3
Identifier200293200B
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 4
Identifier021622129
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS OF ILLINOIS

VIII. Authorized Official

Name: MS. JERLA JANE FREEMAN
Title or Position: CEO PRESIDENT
Credential: CPA
Phone: 219-949-7587