MEDICARE: SAMUEL HERRING JR.

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	172V00000X	Community Health Worker	240170361	IN

General Provider Information

NPI Number	:	1740035831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL HERRING JR.

Provider Business Mailing Address
First Line	:	4530 E 42ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4550
Country	:	US
Telephone Number	:	317-714-9911
Fax Number	:	317-541-0075

Provider Business Practice Location Address
First Line	:	4530 E 42ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4550
Country	:	US
Telephone Number	:	317-714-9911
Fax Number	:	317-541-0075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “ SAMUEL HERRING JR. ” Practice Location

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