Provider Demographics
NPI:1255474060
Name:THE MERRA-LEE SHOPS INC.
Entity Type:Organization
Organization Name:THE MERRA-LEE SHOPS INC.
Other - Org Name:SHE SHE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-232-2640
Mailing Address - Street 1:15 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2232
Mailing Address - Country:US
Mailing Address - Phone:630-232-2640
Mailing Address - Fax:630-232-2677
Practice Address - Street 1:17 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2232
Practice Address - Country:US
Practice Address - Phone:630-232-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1109670001Medicare ID - Type Unspecified