Healthcare Provider Details

I. General information

NPI: 1245776913
Provider Name (Legal Business Name): THE LIFT MAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 FURNAS RD
INDIANAPOLIS IN
46221-4002
US

IV. Provider business mailing address

5940 FURNAS RD
INDIANAPOLIS IN
46221-4002
US

V. Phone/Fax

Practice location:
  • Phone: 317-372-1445
  • Fax:
Mailing address:
  • Phone: 317-372-1445
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM WESLEY KIRK
Title or Position: MEMBER MANAGER
Credential:
Phone: 317-372-1445