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General NPI Number Information
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NPI Number | 1295301216
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Entity Type | Organization
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Legal Business Name | MAIN STREET HOSPICE, LLC
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 10 HIGHLAND AVE
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City | FRANKLIN
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State | IN
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Zip | 46131-1230
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Country | US
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Telephone | 317-736-0055
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Fax | 317-739-3505
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Provider Business Mailing Address
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Address Line | 10 HIGHLAND AVE
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City | FRANKLIN
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State | IN
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Zip | 46131-1230
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Country | US
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Telephone | 317-736-0055
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Fax | 317-739-3505
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Authorized Official
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Title or Position | CFO
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Name | DOUGLAS KEITH WEDDLE
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Credential |
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Telephone | 317-736-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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