Healthcare Provider Details

I. General information

NPI: 1871957274
Provider Name (Legal Business Name): JEFFREY SCHECK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROOSEVELT AVE
INDIANAPOLIS IN
46202-4721
US

IV. Provider business mailing address

PO BOX 441596
INDIANAPOLIS IN
46244-1596
US

V. Phone/Fax

Practice location:
  • Phone: 317-637-0845
  • Fax: 317-637-0847
Mailing address:
  • Phone: 317-637-0845
  • Fax: 317-637-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number332U00000X
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: