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General NPI Number Information
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NPI Number | 1205149218
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Entity Type | Organization
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Legal Business Name | MIDWEST PROVIDER GROUP.DME
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 1449 N PENNSYLVANIA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2420
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Country | US
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Telephone | 317-677-6572
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 NORTH PENNSYLVANIA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202
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Country | US
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Telephone | 317-677-6572
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL K O'NEAL
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Credential |
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Telephone | 317-677-6572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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