Healthcare Provider Details

I. General information

NPI: 1114989712
Provider Name (Legal Business Name): ADMIRAL MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 E 46TH ST STE Q7
INDIANAPOLIS IN
46205-2461
US

IV. Provider business mailing address

2511 E 46TH ST STE Q7
INDIANAPOLIS IN
46205-2461
US

V. Phone/Fax

Practice location:
  • Phone: 317-641-3174
  • Fax: 317-545-1877
Mailing address:
  • Phone: 317-641-3174
  • Fax: 317-545-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0119124416
License Number StateIN

VIII. Authorized Official

Name: MR. RASHARD GRAVES
Title or Position: OWNER
Credential:
Phone: 317-641-3174