Provider Demographics
NPI:1265571939
Name:INDY MEDICAL SUPPLY SERVICES
Entity type:Organization
Organization Name:INDY MEDICAL SUPPLY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILLUS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:BS COMPUTER TECH
Authorized Official - Phone:317-280-8315
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4348
Mailing Address - Country:US
Mailing Address - Phone:317-280-8315
Mailing Address - Fax:317-280-8355
Practice Address - Street 1:3737 NORTH MERIDIAN STREET
Practice Address - Street 2:SUITE 503
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4308
Practice Address - Country:US
Practice Address - Phone:317-280-8315
Practice Address - Fax:317-280-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000203A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444810AMedicaid
IN4712660001Medicare NSC