Healthcare Provider Details

I. General information

NPI: 1932574142
Provider Name (Legal Business Name): PREVMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 WINDHORST WAY STE 100
GREENWOOD IN
46143-8800
US

IV. Provider business mailing address

1499 WINDHORST WAY STE 120
GREENWOOD IN
46143-8800
US

V. Phone/Fax

Practice location:
  • Phone: 317-522-2054
  • Fax: 855-671-4102
Mailing address:
  • Phone: 317-522-2054
  • Fax: 855-671-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA JACKSON
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 317-522-2054