MEDICARE: HOMER LEWIS SCHRECKENGOST D.O.

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	207Q00000X	Family Medicine Physician	OS012432	PA
2	207Q00000X	Family Medicine Physician	006906	AZ
3	207Q00000X	Family Medicine Physician	02006204A	IN

General Provider Information

NPI Number	:	1083680805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOMER LEWIS SCHRECKENGOST D.O.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7979 N SHADELAND AVE STE 350
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2042
Country	:	US
Telephone Number	:	317-621-5356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/24/2020

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Directions to “ HOMER LEWIS SCHRECKENGOST D.O.” Practice Location

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