MEDICARE: PERSONAL INCONTINENT CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0104319771	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073501425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL INCONTINENT CARE, INC.

Provider Business Mailing Address
First Line	:	7501 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4131
Country	:	US
Telephone Number	:	260-483-7720
Fax Number	:	260-483-7721

Provider Business Practice Location Address
First Line	:	7501 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4131
Country	:	US
Telephone Number	:	260-483-7720
Fax Number	:	260-483-7721

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MRS. LORA L ACKER
Credential	:
Telephone Number	:	260-483-7720

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	03/20/2014

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