MEDICARE: MEDINA COUNTY MEDICAL EQUIPMENT CO 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)

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
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	:	1417041948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDINA COUNTY MEDICAL EQUIPMENT CO INC

Provider Business Mailing Address
First Line	:	3750 PRIORITY WAY SOUTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3831
Country	:	US
Telephone Number	:	877-813-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 E HOUSTON ST STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2031
Country	:	US
Telephone Number	:	210-949-1660
Fax Number	:	210-949-0434

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN GEARHEART
Credential	:
Telephone Number	:	317-813-4210

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/20/2025

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