Provider Demographics
NPI:1649572256
Name:STUDIO I LLC
Entity Type:Organization
Organization Name:STUDIO I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CONARD
Authorized Official - Suffix:
Authorized Official - Credentials:CFM, CMF
Authorized Official - Phone:574-231-6470
Mailing Address - Street 1:5340 HOLY CROSS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1470
Mailing Address - Country:US
Mailing Address - Phone:574-231-6470
Mailing Address - Fax:574-231-6472
Practice Address - Street 1:5340 HOLY CROSS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1470
Practice Address - Country:US
Practice Address - Phone:574-231-6470
Practice Address - Fax:574-231-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies