Provider Demographics
NPI:1124184551
Name:B-MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity Type:Organization
Organization Name:B-MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:B-MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BONIFACE
Authorized Official - Middle Name:UTEMEBOR
Authorized Official - Last Name:UJIAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-388-1971
Mailing Address - Street 1:4726 147TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2527
Mailing Address - Country:US
Mailing Address - Phone:708-388-1971
Mailing Address - Fax:708-388-2048
Practice Address - Street 1:4726 147TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2527
Practice Address - Country:US
Practice Address - Phone:708-388-1971
Practice Address - Fax:708-388-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5021120001Medicare ID - Type UnspecifiedDURABLE MEDICAL SUPPLIES