Organization
R BACON ENTERPRISES INC
Active
Other names
Freedom Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN A BACON (VICE PRESIDENT)
(812) 897-1904
Entity
Organization
Contact information
Practice address
1217 WASHINGTON SQUARE, EVANSVILLE, IN 47715
(812) 471-0351
(812) 471-0379
Mailing address
966 N BAKER ROAD, BOONVILLE, IN 47601
(812) 897-1904
(812) 897-0620
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
FDA#1835621
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000193499
ANTHEM
—
01
—
00000093509
ANTHEM
—
01
—
0742058
UMWA
—
01
—
1023713
ACM
—
01
—
286867
HARMONY HEALTHPLAN
—
05
—
90009473
—
KY
Enumeration date
10/27/2006
Last updated
08/22/2020
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