Healthcare Provider Details

I. General information

NPI: 1154665750
Provider Name (Legal Business Name): ADMIRAL MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 KEYSTONE XING SUITE 1300
INDIANAPOLIS IN
46240-4609
US

IV. Provider business mailing address

136 E MARKET ST SUITE 1110
INDIANAPOLIS IN
46204-3204
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-7730
  • Fax: 317-545-1877
Mailing address:
  • Phone: 317-296-7730
  • Fax: 317-545-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RASHARD GRAVES
Title or Position: PRESIDENT
Credential:
Phone: 317-296-7730