Provider Demographics
NPI:1821566639
Name:ICONIC CARE INC
Entity Type:Organization
Organization Name:ICONIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-400-1949
Mailing Address - Street 1:1111 E 54TH ST STE 118
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3580
Mailing Address - Country:US
Mailing Address - Phone:317-744-0039
Mailing Address - Fax:317-449-5960
Practice Address - Street 1:1111 E 54TH ST STE 118
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3580
Practice Address - Country:US
Practice Address - Phone:317-744-0039
Practice Address - Fax:317-449-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies