Provida Medical Supply, Inc.

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

203001360 Issued in IL

Legal business name

PROVIDA MEDICAL SUPPLY, INC.

Practice address

333 Il-83 Ste 206
Mundelein, IL 60060-3117

Phone

(847) 918-8085

Fax

(847) 881-0301

NPI assigned

Nov 14, 2011

Last updated

Nov 10, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Luda Troyak

Title

President

Phone

(847) 918-8085

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1023395381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 IL-83 STE 206",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600603117",
            "telephone_number": "847-918-8085",
            "fax_number": "847-881-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 IL-83 STE 206",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600603117",
            "telephone_number": "847-918-8085",
            "fax_number": "847-881-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDA MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "TROYAK",
        "authorized_official_first_name": "LUDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-918-8085",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "203001360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "203001360",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Joseph Poland, MD
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• Prime Health Care, LTD
• Katelyn Punches, RDN, LDN
• R & R Medical Supply, Inc. (Fair Haven Medical Supply)
• Aaron Raestas, DPM
• Jennifer S. Ramos, DC
• Renee Raville, PSYD

• Oxygen Equipment & Supplies (DME) in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Oxygen Equipment & Supplies (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.