1003812777 NPI number — SERVICE MEDICAL EQUIPMENT, INC

Table of content: (NPI 1003812777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003812777 NPI number — SERVICE MEDICAL EQUIPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICE MEDICAL EQUIPMENT, INC
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:
1003812777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-848-1900
Provider Business Mailing Address Fax Number:
630-324-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5017 CHASE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-848-1900
Provider Business Practice Location Address Fax Number:
630-789-3375
Provider Enumeration Date:
06/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCILINGO
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-848-1900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  203000568 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 215838800 . This is a "DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01671321 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".