MEDICARE: MEDICAL SUPPLY PLUS

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

General Provider Information

NPI Number	:	1487624177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SUPPLY PLUS

Provider Business Mailing Address
First Line	:	5240 FENMORE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2033
Country	:	US
Telephone Number	:	317-557-0304
Fax Number	:	317-557-2456

Provider Business Practice Location Address
First Line	:	5240 FENMORE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2033
Country	:	US
Telephone Number	:	317-557-0304
Fax Number	:	317-557-2456

Authorized Official
Title or Position	:	OWNER
Name	:	DALENE KENO
Credential	:
Telephone Number	:	317-557-0304

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/22/2020

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