Provider Demographics
NPI:1235391376
Name:IDC INC
Entity Type:Organization
Organization Name:IDC INC
Other - Org Name:MEDICAL GASSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-561-1854
Mailing Address - Street 1:958 OLD FINCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9100
Mailing Address - Country:US
Mailing Address - Phone:502-561-1854
Mailing Address - Fax:
Practice Address - Street 1:958 OLD FINCHVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9100
Practice Address - Country:US
Practice Address - Phone:502-561-1854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies