Medical Supply Company of Illinois LLC

Primary specialty

Nursing Facility Supplies (DME)Taxonomy code 332BN1400X

License

28771362 Issued in IL

Legal business name

MEDICAL SUPPLY COMPANY OF ILLINOIS LLC

Practice address

5061 N Pulaski Rd
Suite 204
Chicago, IL 60630-2706

Phone

(773) 487-1186

Fax

(773) 478-1192

NPI assigned

Apr 4, 2007

Last updated

Dec 4, 2007By 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

Mr. Sherman F Della, CPA

Title

Cfo

Phone

(773) 509-0681

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1235251059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5061 N PULASKI RD",
            "address_2": "SUITE 204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302706",
            "telephone_number": "773-487-1186",
            "fax_number": "773-478-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5061 N PULASKI RD",
            "address_2": "SUITE 204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302706",
            "telephone_number": "773-487-1186",
            "fax_number": "773-478-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SUPPLY COMPANY OF ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "DELLA",
        "authorized_official_first_name": "SHERMAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "773-509-0681",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "IL",
            "license": "28771362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility Supplies (DME) in Chicago, IL
• Providers in Chicago, IL by specialty
• Nursing Facility Supplies (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.