Willow Medical Distribution LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

203.001976 Issued in IL

Legal business name

WILLOW MEDICAL DISTRIBUTION LLC

Practice address

19801 Governors Hwy Ste 160
Flossmoor, IL 60422-4363

Phone

(844) 407-7544

NPI assigned

Feb 1, 2018

Organization subpart

No

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

Authorized official

Name

Jeff Blair

Title

Authorized Representative

Phone

(844) 407-7544

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1992204259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 W GRAND AVE",
            "address_2": "STE B #97551",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19801 GOVERNORS HWY STE 160",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604224363",
            "telephone_number": "844-407-7544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW MEDICAL DISTRIBUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "844-407-7544"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.001976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina S Wells
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• Karen N Whitehorn, MD
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• Kobee Wilson
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• Taunya D Woods, LCPC
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• Durable Medical Equipment & Medical Supplies in Flossmoor, IL
• Providers in Flossmoor, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.