Provider Demographics
NPI:1790945947
Name:MAIL ORDER INCONTINENT SUPPLIES LLC
Entity Type:Organization
Organization Name:MAIL ORDER INCONTINENT SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYDONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-203-0630
Mailing Address - Street 1:8470 ALLISON POINTE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4364
Mailing Address - Country:US
Mailing Address - Phone:317-203-0630
Mailing Address - Fax:317-203-7077
Practice Address - Street 1:8470 ALLISON POINTE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4364
Practice Address - Country:US
Practice Address - Phone:317-203-0630
Practice Address - Fax:317-203-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200903660AMedicaid