Brent Duane King
Individual provider Active NPI Home Modifications Contractor · Hanna, IN
NPI 1225344773 · NPPES record last updated Aug 22, 2010
Key facts
- NPI
- 1225344773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Modifications Contractor 171WH0202X
- License
- 8960520176 (IN)
- Practice address
- 12884 S 600 W
Hanna, IN 46340-9788 - Phone
- (219) 405-8509
- Fax
- (219) 733-2561
- NPI assigned
- Aug 22, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8960520176 | IN | MD | Home Modifications Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 8960520176 | IN | Yes |
Addresses
Primary practice location
12884 S 600 W
Hanna, IN 46340-9788
Mailing address
12884 S 600 W
Hanna, IN 46340-9788
Phone (219) 405-8509
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.