Provider Demographics
NPI:1487624177
Name:MEDICAL SUPPLY PLUS
Entity type:Organization
Organization Name:MEDICAL SUPPLY PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-557-0304
Mailing Address - Street 1:5240 FENMORE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2033
Mailing Address - Country:US
Mailing Address - Phone:317-557-0304
Mailing Address - Fax:317-557-2456
Practice Address - Street 1:5240 FENMORE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-2033
Practice Address - Country:US
Practice Address - Phone:317-557-0304
Practice Address - Fax:317-557-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5431620001Medicare ID - Type Unspecified