Provider Demographics
NPI:1043556509
Name:INDIANA MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:INDIANA MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENITO-REFUGIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-917-2123
Mailing Address - Street 1:5627 HALLIE RAE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8199
Mailing Address - Country:US
Mailing Address - Phone:812-230-5700
Mailing Address - Fax:812-917-2123
Practice Address - Street 1:5627 HALLIE RAE LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-8199
Practice Address - Country:US
Practice Address - Phone:812-230-5700
Practice Address - Fax:812-917-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003052A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty