Healthcare Provider Details

I. General information

NPI: 1366703399
Provider Name (Legal Business Name): DEXTER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FULTON ST
LOGANSPORT IN
46947-1577
US

IV. Provider business mailing address

800 FULTON ST
LOGANSPORT IN
46947-1577
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-5678
  • Fax: 574-753-5597
Mailing address:
  • Phone: 574-722-5678
  • Fax: 574-753-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69000792A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCFM00432
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCFTS0099
License Number StateIN

VIII. Authorized Official

Name: CHRISTINE FARNHAM
Title or Position: CO-OWNER
Credential: RPH.
Phone: 574-722-5678