MEDICARE: INCREMEDICAL, LLC

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	225100000X	Physical Therapist	N/A	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	:	1417900457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCREMEDICAL, LLC

Provider Business Mailing Address
First Line	:	8259 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	219-365-6560
Fax Number	:	219-365-7703

Provider Business Practice Location Address
First Line	:	8261 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	219-365-1133
Fax Number	:	219-365-7703

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	ANN MARSHALL
Credential	:
Telephone Number	:	219-365-6559

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/04/2009

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Directions to “INCREMEDICAL, LLC ” Practice Location

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