Healthcare Provider Details

I. General information

NPI: 1689013914
Provider Name (Legal Business Name): MULLANEY MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 N SHERMAN DR SUITE A
INDIANAPOLIS IN
46218-4500
US

IV. Provider business mailing address

1775 N SHERMAN DR SUITE A
INDIANAPOLIS IN
46218-4500
US

V. Phone/Fax

Practice location:
  • Phone: 317-495-9461
  • Fax: 317-495-9462
Mailing address:
  • Phone: 317-495-9461
  • Fax: 317-495-9462

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
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS P MULLANEY
Title or Position: PRESIDETN
Credential: R.PH.
Phone: 513-587-6201