Provider Demographics
NPI:1306174487
Name:INDY MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:INDY MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:317-431-7345
Mailing Address - Street 1:650 S 800 E
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9716
Mailing Address - Country:US
Mailing Address - Phone:317-431-7345
Mailing Address - Fax:317-769-3847
Practice Address - Street 1:650 S 800 E
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9716
Practice Address - Country:US
Practice Address - Phone:317-431-7345
Practice Address - Fax:317-769-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN335V00000X335V00000X
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier