Healthcare Provider Details

I. General information

NPI: 1992613590
Provider Name (Legal Business Name): INDIANA FAMILY MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 HEMLOCK LN
GARY IN
46403-2222
US

IV. Provider business mailing address

8831 HEMLOCK LN
GARY IN
46403-2222
US

V. Phone/Fax

Practice location:
  • Phone: 909-835-7308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. LANCE MARCELLUS GREGORY JR.
Title or Position: DIRECTOR
Credential:
Phone: 909-835-7308