1538298542 NPI number — ILLINOIS DURABLE MEDICAL EQUIPMENT & SUPPLY, INC.

Table of content: (NPI 1538298542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538298542 NPI number — ILLINOIS DURABLE MEDICAL EQUIPMENT & SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILLINOIS DURABLE MEDICAL EQUIPMENT & SUPPLY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1538298542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1099 N CORPORATE CIR
Provider Second Line Business Mailing Address:
UNIT H & I
Provider Business Mailing Address City Name:
GRAYSLAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60030-1688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-548-8688
Provider Business Mailing Address Fax Number:
847-548-8686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1099 N CORPORATE CIR
Provider Second Line Business Practice Location Address:
UNIT H & I
Provider Business Practice Location Address City Name:
GRAYSLAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60030-1688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-548-8688
Provider Business Practice Location Address Fax Number:
847-548-8686
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DVORKIN
Authorized Official First Name:
VALERY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-548-8688

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  002 , 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)





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