Provider Demographics
NPI:1629254362
Name:RICHARD J. LOESCH, D.P.M.
Entity Type:Organization
Organization Name:RICHARD J. LOESCH, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LOESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-386-6750
Mailing Address - Street 1:418 1/2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1516
Mailing Address - Country:US
Mailing Address - Phone:812-386-6750
Mailing Address - Fax:812-385-3667
Practice Address - Street 1:418 1/2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1516
Practice Address - Country:US
Practice Address - Phone:812-386-6750
Practice Address - Fax:812-385-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000440332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4646650001Medicare NSC