Provider Demographics
NPI:1114009222
Name:ACCESS HEALTH MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:ACCESS HEALTH MEDICAL SUPPLIES INC.
Other - Org Name:ACCESS HEALTH MEDICAL SUPPLIES AND HOME HEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ILOEGBUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-221-4273
Mailing Address - Street 1:122 WEST 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1320
Mailing Address - Country:US
Mailing Address - Phone:773-221-4273
Mailing Address - Fax:773-221-4565
Practice Address - Street 1:122 WEST 95TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1320
Practice Address - Country:US
Practice Address - Phone:773-221-4273
Practice Address - Fax:773-221-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
5619320001Medicare NSC