Provider Demographics
NPI:1003003278
Name:MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:MEDICAL SUPPLIES, INC
Other - Org Name:RELIABLE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-612-5641
Mailing Address - Street 1:623 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3608
Mailing Address - Country:US
Mailing Address - Phone:847-566-0800
Mailing Address - Fax:847-566-0866
Practice Address - Street 1:623 S LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3608
Practice Address - Country:US
Practice Address - Phone:847-566-0800
Practice Address - Fax:847-566-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid