Provider Demographics
NPI:1760492268
Name:ST ANNAS MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:ST ANNAS MEDICAL SERVICES INC
Other - Org Name:ST DOROTHYS DME SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAND-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-283-6640
Mailing Address - Street 1:3266 N MERIDIAN ST
Mailing Address - Street 2:ST ANNAS MED SERV INC
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5846
Mailing Address - Country:US
Mailing Address - Phone:317-283-6640
Mailing Address - Fax:317-283-1955
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:ST ANNAS MED SERV INC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-283-6640
Practice Address - Fax:317-283-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4690740001Medicare ID - Type Unspecified