Provider Demographics
NPI:1710079785
Name:PEARCE MEDICAL LLC
Entity Type:Organization
Organization Name:PEARCE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:812-484-4932
Mailing Address - Street 1:PO BOX 23021
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47724-1021
Mailing Address - Country:US
Mailing Address - Phone:812-484-4932
Mailing Address - Fax:812-909-0551
Practice Address - Street 1:113 E EICHEL AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4503
Practice Address - Country:US
Practice Address - Phone:812-484-4932
Practice Address - Fax:812-909-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0119506750332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5222380001Medicare NSC