Provider Demographics
NPI:1225064793
Name:MEDICAL SUPPLY PLUS INC
Entity Type:Organization
Organization Name:MEDICAL SUPPLY PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JERLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-949-7587
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409
Mailing Address - Country:US
Mailing Address - Phone:219-949-7587
Mailing Address - Fax:219-949-7860
Practice Address - Street 1:1982 GRANT STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404
Practice Address - Country:US
Practice Address - Phone:219-949-7587
Practice Address - Fax:219-949-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200293200AMedicaid
IN48001666AOtherWHOLESALE DRUG DIS REFER
IN200293200BMedicaid
IL021622129OtherBCBS OF ILLINOIS
IN200293200AMedicaid
IN200293200BMedicaid
IN4142150001Medicare NSC