Healthcare Provider Details
I. General information
NPI: 1780094524
Provider Name (Legal Business Name): SEMCOTECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/01/2014
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
10291 N MERIDIAN ST SUITE #170
INDIANAPOLIS IN
46290-1076
US
IV. Provider business mailing address
10291 N MERIDIAN ST STE 170
INDIANAPOLIS IN
46290-1000
US
V. Phone/Fax
- Phone: 317-973-0888
- Fax:
- Phone: 317-658-4987
- Fax: 833-884-9394
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 172M00000X |
| Taxonomy | Mechanotherapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 175L00000X |
| Taxonomy | Homeopath |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
STEVEN
EDWARD
MASCHMEYER
Title or Position: MEMBER
Credential: CMTPT, LMT, BS
Phone: 317-658-4987