Provider Demographics
NPI:1154665750
Name:ADMIRAL MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:ADMIRAL MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RASHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-296-7730
Mailing Address - Street 1:136 E MARKET ST
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3204
Mailing Address - Country:US
Mailing Address - Phone:317-296-7730
Mailing Address - Fax:317-545-1877
Practice Address - Street 1:8888 KEYSTONE XING
Practice Address - Street 2:SUITE 1300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4609
Practice Address - Country:US
Practice Address - Phone:317-296-7730
Practice Address - Fax:317-545-1877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADMIRAL MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-20
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty