MEDICARE: S&P MEDICAL GROUP, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134679947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&P MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2448 N TALBOTT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-4352
Country	:	US
Telephone Number	:	317-518-5799
Fax Number	:

Provider Business Practice Location Address
First Line	:	2448 N TALBOTT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-4352
Country	:	US
Telephone Number	:	317-518-5799
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	BRIAN SCOTT
Credential	:
Telephone Number	:	317-518-5799

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	10/05/2016

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