1568657708 NPI number — AMERICAN DME 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 1568657708 NPI number — AMERICAN DME SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN DME 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:
1568657708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1314 W NORTHWEST HWY
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60004-5261
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:
1314 W NORTHWEST HWY
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60004-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-577-8301
Provider Business Practice Location Address Fax Number:
847-577-8302
Provider Enumeration Date:
09/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PROZUMENT
Authorized Official First Name:
MARIANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-577-8301

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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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