Provider Demographics
NPI:1033193560
Name:UBN CORPORATION
Entity Type:Organization
Organization Name:UBN CORPORATION
Other - Org Name:NORTHWEST MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:N
Authorized Official - Last Name:UBANWA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:219-756-6607
Mailing Address - Street 1:100 W 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5439
Mailing Address - Country:US
Mailing Address - Phone:219-756-6607
Mailing Address - Fax:219-756-6627
Practice Address - Street 1:100 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5439
Practice Address - Country:US
Practice Address - Phone:219-756-6607
Practice Address - Fax:219-756-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48001521A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4638970001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER