Provider Demographics
NPI:1295301216
Name:MAIN STREET HOSPICE, LLC
Entity type:Organization
Organization Name:MAIN STREET HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-736-0055
Mailing Address - Street 1:10 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1230
Mailing Address - Country:US
Mailing Address - Phone:317-736-0055
Mailing Address - Fax:317-739-3505
Practice Address - Street 1:10 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1230
Practice Address - Country:US
Practice Address - Phone:317-736-0055
Practice Address - Fax:317-739-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty