Provider Demographics
NPI:1356330690
Name:MEDWORKS, INC
Entity Type:Organization
Organization Name:MEDWORKS, INC
Other - Org Name:CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-392-3737
Mailing Address - Street 1:30 W RAMPART ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-392-3737
Mailing Address - Fax:317-392-9266
Practice Address - Street 1:30 W RAMPART ST
Practice Address - Street 2:SUITE 140
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8846
Practice Address - Country:US
Practice Address - Phone:317-392-3737
Practice Address - Fax:317-392-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005416A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1519391OtherNCPDP
IN100353070Medicaid