Provider Demographics
NPI:1326110560
Name:INDIANA SLEEP & RESPIRATORY CARE INC
Entity Type:Organization
Organization Name:INDIANA SLEEP & RESPIRATORY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-403-6464
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1507
Mailing Address - Country:US
Mailing Address - Phone:812-273-2201
Mailing Address - Fax:812-273-5663
Practice Address - Street 1:635 GREEN RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1507
Practice Address - Country:US
Practice Address - Phone:812-273-2201
Practice Address - Fax:812-273-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000106A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200802350AMedicaid
IN69000106AOtherBD OF PHARMACY HME LICENS
IN69000106AOtherBD OF PHARMACY HME LICENS