Provider Demographics
NPI:1275960130
Name:SENEGAL ENTERPRISES MEDICAL, INC
Entity Type:Organization
Organization Name:SENEGAL ENTERPRISES MEDICAL, INC
Other - Org Name:SE MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MJ
Authorized Official - Middle Name:J
Authorized Official - Last Name:SENEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:563-340-1602
Mailing Address - Street 1:3342 BRAMANTI TRL
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-6113
Mailing Address - Country:US
Mailing Address - Phone:563-340-1602
Mailing Address - Fax:708-757-3692
Practice Address - Street 1:3330 181ST PLACE, SUITE 103
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438
Practice Address - Country:US
Practice Address - Phone:563-340-1602
Practice Address - Fax:708-757-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.001596332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies