Provider Demographics
NPI:1255403952
Name:DIAPER KING CLUB INC.
Entity type:Organization
Organization Name:DIAPER KING CLUB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGERCCO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-924-2464
Mailing Address - Street 1:4011 MILLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2851
Mailing Address - Country:US
Mailing Address - Phone:317-924-2464
Mailing Address - Fax:317-924-3171
Practice Address - Street 1:4011 MILLERSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2851
Practice Address - Country:US
Practice Address - Phone:317-924-2464
Practice Address - Fax:317-924-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies