Provider Demographics
NPI:1073922688
Name:CHANEY ENERGY GROUP LLC
Entity Type:Organization
Organization Name:CHANEY ENERGY GROUP LLC
Other - Org Name:MINORITY SOURCE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-339-9087
Mailing Address - Street 1:6678 GUION RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2534
Mailing Address - Country:US
Mailing Address - Phone:317-339-9087
Mailing Address - Fax:866-760-7030
Practice Address - Street 1:6678 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2534
Practice Address - Country:US
Practice Address - Phone:317-339-9087
Practice Address - Fax:866-760-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies