MEDICARE: BARRY & JOHNSON, ASSOC, LLC

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	314000000X	Skilled Nursing Facility		IN

General Provider Information

NPI Number	:	1104826015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY & JOHNSON, ASSOC, LLC

Provider Business Mailing Address
First Line	:	3208 N SHERMAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2173
Country	:	US
Telephone Number	:	317-543-0681
Fax Number	:	317-543-0753

Provider Business Practice Location Address
First Line	:	3208 N SHERMAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2173
Country	:	US
Telephone Number	:	317-543-0681
Fax Number	:	317-543-0753

Authorized Official
Title or Position	:	OWNER
Name	:	BERDER M JOHNSON
Credential	:
Telephone Number	:	317-543-0681

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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