1417142365 NPI number — PERINATAL HOME MEDICAL SUPPLY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417142365 NPI number — PERINATAL HOME MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERINATAL HOME MEDICAL SUPPLY, 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:
1417142365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9449 S KEDZIE AVE STE 380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60805-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9635 S WINCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60643-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-517-2720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULCRONE
Authorized Official First Name:
SANDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / EXECUTIVE OFFICER
Authorized Official Telephone Number:
773-517-2720

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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