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General NPI Number Information
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NPI Number | 1003133240
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Entity Type | Organization
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Legal Business Name | LCP MEDICAL DIRECT LLC
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 4308 GUION RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3143
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Country | US
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Telephone | 765-749-3791
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Fax | 317-388-9151
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Provider Business Mailing Address
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Address Line | 4308 GUION RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3143
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Country | US
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Telephone | 317-388-9150
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Fax | 317-291-6004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAVONNDA S RAINES
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Credential |
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Telephone | 317-388-9150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0102114331
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License Number State | IN
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