Provider Demographics
NPI:1831722156
Name:A-WARNOCK-LLC
Entity type:Organization
Organization Name:A-WARNOCK-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-346-7722
Mailing Address - Street 1:1103 CENTRAL PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 S STATE ST STE 217
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2553
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023962Medicaid