MEDICARE: MIDWEST PROVIDER GROUP.DME

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205149218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PROVIDER GROUP.DME

Provider Business Mailing Address
First Line	:	1449 NORTH PENNSYLVANIA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-677-6572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 N PENNSYLVANIA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2420
Country	:	US
Telephone Number	:	317-677-6572
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL K O'NEAL
Credential	:
Telephone Number	:	317-677-6572

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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