Provider Demographics
NPI:1992702047
Name:HANKINS-CONRAD MEDICAL, INC.
Entity type:Organization
Organization Name:HANKINS-CONRAD MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-513-6965
Mailing Address - Street 1:12370 PETALON TRACE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037
Mailing Address - Country:US
Mailing Address - Phone:800-513-6965
Mailing Address - Fax:800-513-6997
Practice Address - Street 1:12370 PETALON TRACE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:800-513-6965
Practice Address - Fax:800-513-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1252080001Medicare NSC