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General NPI Number Information
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NPI Number | 1497425912
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Entity Type | Organization
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Legal Business Name | CRANIAL PROSTHESIS SPECIALIST
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 5126 N FRANKLIN RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-2050
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Country | US
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Telephone | 317-556-3923
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 N GERMAN CHURCH RD # 3049
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-8513
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Country | US
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Telephone | 833-633-9447
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Fax | 833-633-9447
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Authorized Official
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Title or Position | OWNER
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Name | GHYMINA LONG
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Credential |
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Telephone | 317-556-3923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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