MEDICARE: ADMIRAL MEDICAL SUPPLY, 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1154665750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMIRAL MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	136 E MARKET ST
Second Line	:	SUITE 1110
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3204
Country	:	US
Telephone Number	:	317-296-7730
Fax Number	:	317-545-1877

Provider Business Practice Location Address
First Line	:	8888 KEYSTONE XING
Second Line	:	SUITE 1300
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-4609
Country	:	US
Telephone Number	:	317-296-7730
Fax Number	:	317-545-1877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RASHARD GRAVES
Credential	:
Telephone Number	:	317-296-7730

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	03/07/2013

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