Provider Demographics
NPI:1275824039
Name:MEDLINE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MEDLINE MEDICAL SUPPLY INC
Other - Org Name:US MEDICAL EQUIPMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-465-0040
Mailing Address - Street 1:8938 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5163
Mailing Address - Country:US
Mailing Address - Phone:773-465-0040
Mailing Address - Fax:
Practice Address - Street 1:8938 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5163
Practice Address - Country:US
Practice Address - Phone:773-465-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies