Provider Demographics
NPI:1801046313
Name:BETTY & RICHARD MUNRO
Entity type:Organization
Organization Name:BETTY & RICHARD MUNRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-362-0448
Mailing Address - Street 1:136 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1718
Mailing Address - Country:US
Mailing Address - Phone:765-362-0448
Mailing Address - Fax:
Practice Address - Street 1:136 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1718
Practice Address - Country:US
Practice Address - Phone:765-362-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0002105055332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6409430001Medicare NSC