Provider Demographics
NPI:1275695686
Name:CARDINAL HOME MEDICAL LLC
Entity Type:Organization
Organization Name:CARDINAL HOME MEDICAL LLC
Other - Org Name:CARDINAL HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-593-9300
Mailing Address - Street 1:722 BUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-5235
Mailing Address - Country:US
Mailing Address - Phone:765-593-9300
Mailing Address - Fax:765-593-9304
Practice Address - Street 1:722 BUNDY AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-5235
Practice Address - Country:US
Practice Address - Phone:765-593-9300
Practice Address - Fax:765-593-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200851890AMedicaid
IN200851890AMedicaid