1811997638 NPI number — MEDLINE INDUSTRIES, LP

Table of content: (NPI 1811997638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811997638 NPI number — MEDLINE INDUSTRIES, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDLINE INDUSTRIES, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811997638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 LAKES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60093-2753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-265-6512
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 CORNERSTONE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAYSLAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60030-9712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-327-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOYLE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
AUTHORIZED PERSON
Authorized Official Telephone Number:
844-265-6512

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  203001682 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1811997638 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90032335 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00410369 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021896 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194904716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2429400 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98000060 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143546900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811997638 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009052300005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00457949A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00680891 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036021 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0400435 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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