MEDICARE: EBONY JACKS

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1104574896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY JACKS

Provider Business Mailing Address
First Line	:	1011 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3223
Country	:	US
Telephone Number	:	260-508-6752
Fax Number	:

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

Provider Enumeration Date	:	03/13/2022
Last Update Date	:	06/07/2022

Similar Medicare Providers

1508081654 — ROBERT J. ROBINSON MD MEDICAL CORPORATION
Practice Location Address:

4018 E SOUTHPORT RD
INDIANAPOLIS, IN
46237-3223

Practice Phone: 317-787-3276
Practice Fax: 317-787-3043

1750089751 — MRS. SAMANTHA MAGDALENE MULLINS
Practice Location Address:

3339 CARPENTER CT
INDIANAPOLIS, IN
46203-3223

Practice Phone: 317-410-2116
Practice Fax:

1902115090 — AMY REBECCA CLAYTON ANP
Practice Location Address:

1500 N RITTER AVE
INDIANAPOLIS, IN
46219-3027

Practice Phone: 317-552-2463
Practice Fax:

1871448779 — MEGAN SHEPPARD
Practice Location Address:

1400 N RITTER AVE
INDIANAPOLIS, IN
46219-3052

Practice Phone: 317-355-1411
Practice Fax:

1881540706 — ROYAL HEARTZ HOME CARE
Practice Location Address:

1387 N SHADELAND AVE STE G
INDIANAPOLIS, IN
46219-3605

Practice Phone: 317-435-2328
Practice Fax:

1639029903 — THREADS OF HEALING COUNSELING LLC
Practice Location Address:

48 N IRWIN ST
INDIANAPOLIS, IN
46219-6209

Practice Phone: 317-325-8230
Practice Fax:

Directions to “ EBONY JACKS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.