Organization
TERRIA CONWELL
Active
Other names
ACL Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRIA CONWELL (OWNER)
(219) 628-5672
Entity
Organization
Contact information
Practice address
5835 JESSICA AVE, PORTAGE, IN 46368-1662
(219) 628-5672
Mailing address
5835 JESSICA AVE, PORTAGE, IN 46368-1662
(219) 628-5672
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699054080
—
IN
Enumeration date
07/20/2020
Last updated
07/20/2020
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