Iconic Care Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ICONIC CARE INC

Practice address

1111 E 54TH St Ste 118
Indianapolis, IN 46220-3580

Phone

(317) 744-0039

Fax

(317) 449-5960

NPI assigned

Nov 9, 2018

Organization subpart

No

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

Authorized official

Name

Kyle Howard Butler

Title

Ceo/President

Phone

(317) 400-1949

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1821566639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E 54TH ST STE 118",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462203580",
            "telephone_number": "317-744-0039",
            "fax_number": "317-449-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E 54TH ST STE 118",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462203580",
            "telephone_number": "317-744-0039",
            "fax_number": "317-449-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "317-400-1949"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.