Organization
PROSTHETIC CENTER OF INDIANA, LLC
Active
Other names
Prosthetic Center of Indiana
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES WILLIAM DEWEES C.P. (OWNER)
(812) 332-5347
Entity
Organization
Contact information
Practice address
321 E WINSLOW RD, BLOOMINGTON, IN 47401-8648
(812) 332-5347
(812) 323-2939
Mailing address
321 E WINSLOW RD, BLOOMINGTON, IN 47401-8648
(812) 332-5347
(812) 323-2939
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000301965
ANTHEM
IN
Enumeration date
01/04/2007
Last updated
08/22/2020
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