MEDICARE: INDY MEDICAL SUPPLY SERVICES

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	69000203A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265571939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDY MEDICAL SUPPLY SERVICES

Provider Business Mailing Address
First Line	:	3737 N MERIDIAN ST
Second Line	:	SUITE 503
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-4348
Country	:	US
Telephone Number	:	317-280-8315
Fax Number	:	317-280-8355

Provider Business Practice Location Address
First Line	:	3737 NORTH MERIDIAN STREET
Second Line	:	SUITE 503
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-4308
Country	:	US
Telephone Number	:	317-280-8315
Fax Number	:	317-280-8355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CAMILLUS RICHARD INYANG
Credential	:	BS COMPUTER TECH
Telephone Number	:	317-280-8315

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/14/2016

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