Provider Demographics
NPI:1134105737
Name:PERSONAL MEDICAL EQUIPMENT AND SERVICES, INC
Entity Type:Organization
Organization Name:PERSONAL MEDICAL EQUIPMENT AND SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOMMYE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-4444
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:517 E VIENNA, SUITE D
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-0089
Mailing Address - Country:US
Mailing Address - Phone:618-833-4444
Mailing Address - Fax:618-833-4445
Practice Address - Street 1:517 E VIENNA
Practice Address - Street 2:STE D
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-0089
Practice Address - Country:US
Practice Address - Phone:618-833-4444
Practice Address - Fax:618-833-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid