# FIRST MEDIVAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720368848
- **Authorized official:** MARK L MOTSINGER (OWNER)
- **Authorized official phone:** (765) 623-4887

## Contact information

- **Practice address:** 8800 S STATE ROAD 109, MARKLEVILLE, IN 46056-9783
- **Practice address phone:** (765) 623-4887
- **Mailing address:** 8800 S STATE ROAD 109, MARKLEVILLE, IN 46056-9783
- **Mailing address phone:** (765) 623-4887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 347C00000X | Private Vehicle | 0030-11-8625 | IN | Yes |

## Other

- **Enumeration date:** 08/20/2011
- **Last updated:** 08/20/2011