Healthcare Provider Details

I. General information

NPI: 1235391376
Provider Name (Legal Business Name): IDC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 OLD FINCHVILLE RD
SHELBYVILLE KY
40065-9100
US

IV. Provider business mailing address

958 OLD FINCHVILLE RD
SHELBYVILLE KY
40065-9100
US

V. Phone/Fax

Practice location:
  • Phone: 502-561-1854
  • Fax:
Mailing address:
  • Phone: 502-561-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateKY

VIII. Authorized Official

Name: LYNDELL L SHEPHERD
Title or Position: OWNER
Credential:
Phone: 502-561-1854