Provider Demographics
NPI:1083805923
Name:K & R MEDICAL SUPPLIES. INC
Entity Type:Organization
Organization Name:K & R MEDICAL SUPPLIES. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-970-9044
Mailing Address - Street 1:326 N SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2323
Mailing Address - Country:US
Mailing Address - Phone:847-970-9044
Mailing Address - Fax:847-970-9066
Practice Address - Street 1:326 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2323
Practice Address - Country:US
Practice Address - Phone:847-970-9044
Practice Address - Fax:847-970-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
6022030001Medicare PIN