Radiance Renewed

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

RADIANCE RENEWED

Practice address

9445 Indianapolis Blvd Ste 1042
Highland, IN 46322-2648

Phone

(219) 689-9104

Fax

(985) 251-2701

NPI assigned

Apr 26, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tatanisha Wright

Title

Owner

Phone

(219) 689-9104

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587859200000",
    "number": "1154941557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9445 INDIANAPOLIS BLVD STE 1042",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463222648",
            "telephone_number": "219-689-9104",
            "fax_number": "985-251-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9445 INDIANAPOLIS BLVD STE 1042",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463222648",
            "telephone_number": "219-689-9104",
            "fax_number": "985-251-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANCE RENEWED",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-26",
        "last_updated": "2020-04-26",
        "certification_date": "2020-04-26",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "TATANISHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-689-9104"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "(985)251-2701",
            "affiliation": "N",
            "endpointDescription": "Fax #",
            "address_1": "9445 Indianapolis Blvd Ste 1042",
            "city": "Highland",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463222648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Highland, IN
• Providers in Highland, IN by specialty
• Prosthetic/Orthotic Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.