Healthcare Provider Details

I. General information

NPI: 1093984155
Provider Name (Legal Business Name): DR RICK D BAUER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
LOOGOOTEE IN
47553-1506
US

IV. Provider business mailing address

PO BOX 296
LOOGOOTEE IN
47553-0296
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-3163
  • Fax:
Mailing address:
  • Phone: 812-295-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RICK D BAUER
Title or Position: OWNER
Credential:
Phone: 812-295-3163