Provider Demographics
NPI:1285814251
Name:HANKINS-CONRAD MEDICAL, INC.
Entity Type:Organization
Organization Name:HANKINS-CONRAD MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:ABC-COF
Authorized Official - Phone:317-845-0343
Mailing Address - Street 1:10821 TURNE GRV
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9006
Mailing Address - Country:US
Mailing Address - Phone:317-845-0343
Mailing Address - Fax:317-845-0373
Practice Address - Street 1:10821 TURNE GRV
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9006
Practice Address - Country:US
Practice Address - Phone:317-845-0343
Practice Address - Fax:317-845-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1252080002Medicare NSC