Provider Demographics
NPI:1225097876
Name:CENTRAL IL MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:CENTRAL IL MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:309-827-3459
Mailing Address - Street 1:203 E LOCUST ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3077
Mailing Address - Country:US
Mailing Address - Phone:309-827-3459
Mailing Address - Fax:309-827-4638
Practice Address - Street 1:203 E LOCUST ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3077
Practice Address - Country:US
Practice Address - Phone:309-827-3459
Practice Address - Fax:309-827-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000065332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203000065OtherLICESNSE NUMBER
IL=========001Medicaid
IL=========001Medicaid