Organization
R BACON ENTERPRISES INC
Active
Organization
R BACON ENTERPRISES INC
Active
Other names
Freedom Medical Boonville 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
966 N BAKER RD, BOONVILLE, IN 47601-9509
(812) 897-1904
(812) 897-0620
Mailing address
966 N BAKER RD, BOONVILLE, IN 47601-9509
(812) 897-1904
(812) 897-0620
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
FDA1835621
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097303
ANTHEM
—
01
—
000000107530
ANTHEM
—
01
—
000000193499
ANTHEM
—
01
—
000000193509
ANTHEM
—
01
—
000000335185
ANTHEM
—
01
—
000000335186
ANTHEM
—
01
—
0742058
UMWA
—
01
—
1023713
ACM
IN
01
—
286867
HARMONY HEALTH PLAN
IN
01
—
8200169
UNITED HEALTHCARE
—
05
—
90009473
—
KY
Enumeration date
02/09/2006
Last updated
08/22/2020
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