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General NPI Number Information
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NPI Number | 1922071984
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Entity Type | Organization
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Legal Business Name | R BACON ENTERPRISES INC
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 966 N BAKER RD
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City | BOONVILLE
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State | IN
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Zip | 47601-9509
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Country | US
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Telephone | 812-897-1904
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Fax | 812-897-0620
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Provider Business Mailing Address
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Address Line | 966 N BAKER RD
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City | BOONVILLE
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State | IN
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Zip | 47601-9509
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Country | US
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Telephone | 812-897-1904
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Fax | 812-897-0620
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. KAREN A BACON
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Credential |
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Telephone | 812-897-1904
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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 | FDA1835621
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License Number State | IN
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