Provider Demographics
NPI:1780663823
Name:ALICK'S HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:ALICK'S HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAFE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-273-6000
Mailing Address - Street 1:17187 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1521
Mailing Address - Country:US
Mailing Address - Phone:574-273-6000
Mailing Address - Fax:574-247-8199
Practice Address - Street 1:17187 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1521
Practice Address - Country:US
Practice Address - Phone:574-273-6000
Practice Address - Fax:574-247-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7542OtherPHYSICIAN'S HEALTH PLAN
IN000000303785OtherANTHEM BCBS
IN0215100003Medicare NSC