Healthcare Provider Details

I. General information

NPI: 1992750756
Provider Name (Legal Business Name): PARAMOUNT OF INDIANAPOLIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

IV. Provider business mailing address

350 EVERGREEN RD SUITE 3
LOUISVILLE KY
40243-1010
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-9955
  • Fax:
Mailing address:
  • Phone: 502-254-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number100267690B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100267690B
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000195-1
License Number StateIN

VIII. Authorized Official

Name: MR. MICHAEL PAUL TURNER SR.
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 520-254-4949