Provider Demographics
NPI:1235251059
Name:MEDICAL SUPPLY COMPANY OF ILLINOIS LLC
Entity Type:Organization
Organization Name:MEDICAL SUPPLY COMPANY OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:773-509-0681
Mailing Address - Street 1:5061 N PULASKI RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2706
Mailing Address - Country:US
Mailing Address - Phone:773-487-1186
Mailing Address - Fax:773-478-1192
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:773-487-1186
Practice Address - Fax:773-478-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28771362332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1198930001Medicare NSC