Provider Demographics
NPI:1841574928
Name:B & H MEDICAL LLC - INDY
Entity Type:Organization
Organization Name:B & H MEDICAL LLC - INDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-425-5637
Mailing Address - Street 1:10661 ANDRADE DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9230
Mailing Address - Country:US
Mailing Address - Phone:877-504-6373
Mailing Address - Fax:317-663-2542
Practice Address - Street 1:10661 ANDRADE DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9230
Practice Address - Country:US
Practice Address - Phone:877-504-6373
Practice Address - Fax:317-663-2542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B & H MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H20230OtherBCBS PROVIDER NUMBER
MI4641926Medicaid