MEDICARE: INDIAN VALLEY HEALTHCARE 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750096061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIAN VALLEY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 64764
Second Line	:
City	:	SOUDERTON
State	:	PA
Zip	:	18964-0764
Country	:	US
Telephone Number	:	484-588-9929
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 STRAFFORD AVE STE 202
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-3317
Country	:	US
Telephone Number	:	484-588-9929
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	MR. THOMAS WILLIAMSON
Credential	:
Telephone Number	:	484-588-9929

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	05/27/2026

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