Provider Demographics
NPI:1053549030
Name:MIRACLE MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:MIRACLE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:CHANELL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-876-5840
Mailing Address - Street 1:8857 COMMERCE PARK PL
Mailing Address - Street 2:A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3170
Mailing Address - Country:US
Mailing Address - Phone:317-876-5840
Mailing Address - Fax:317-876-5841
Practice Address - Street 1:8857 COMMERCE PARK PL
Practice Address - Street 2:A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3170
Practice Address - Country:US
Practice Address - Phone:317-876-5840
Practice Address - Fax:317-876-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies