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Organization

LCP MEDICAL DIRECT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LAVONNDA S RAINES (PRESIDENT)
(317) 388-9150
Entity
Organization

Contact information

Practice address
4308 GUION RD STE A, INDIANAPOLIS, IN 46254-3143
(765) 749-3791
(317) 388-9151
Mailing address
4308 GUION RD STE A, INDIANAPOLIS, IN 46254-3143
(317) 388-9150
(317) 291-6004

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0102114331
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200319370A
IN
Enumeration date
04/28/2010
Last updated
10/10/2011
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