MEDICARE: ACCESS ONE BY MSG 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	332BC3200X	Customized Equipment (DME)	0132993023	IN
2	332BD1200X	Dialysis Equipment & Supplies (DME)	0132993023	IN
3	332BN1400X	Nursing Facility Supplies (DME)	0132993023	IN
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	0132993023	IN
5	332B00000X	Durable Medical Equipment & Medical Supplies	0132993023	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	610371770	OTHER	IN	DUN & BRADSTREET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336562321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ONE BY MSG INC.

Provider Business Mailing Address
First Line	:	6652 SAINT JOE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1974
Country	:	US
Telephone Number	:	260-485-7007
Fax Number	:	260-486-7887

Provider Business Practice Location Address
First Line	:	6652 SAINT JOE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1974
Country	:	US
Telephone Number	:	260-485-7007
Fax Number	:	260-486-7887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK STEVEN GAWEL
Credential	:
Telephone Number	:	260-485-7007

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	06/20/2018

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Directions to “ACCESS ONE BY MSG INC. ” Practice Location

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