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Organization

MEDICARE SUPPLY STORE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RYAN MICHAEL THOMAS H.I.S. (VICE PRESIDENT)
(317) 557-9090
Entity
Organization

Contact information

Practice address
3510 S KEYSTONE AVE, INDIANAPOLIS, IN 46227-3610
(317) 215-5883
(877) 783-2054
Mailing address
3510 S KEYSTONE AVE, INDIANAPOLIS, IN 46227-3610
(317) 215-5883
(877) 783-2054

Taxonomy

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

Other

Enumeration date
04/21/2009
Last updated
04/21/2009
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