Provider Demographics
NPI:1003970690
Name:MCKANE MEDICAL & HOSPITAL SUPPLIES INC
Entity Type:Organization
Organization Name:MCKANE MEDICAL & HOSPITAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:EBONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-852-4011
Mailing Address - Street 1:5252 S HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1723
Mailing Address - Country:US
Mailing Address - Phone:219-852-4011
Mailing Address - Fax:219-852-4012
Practice Address - Street 1:5252 S HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1723
Practice Address - Country:US
Practice Address - Phone:219-852-4011
Practice Address - Fax:219-852-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5833210001Medicare NSC