Provider Demographics
NPI:1326089731
Name:DIRECT MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:DIRECT MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:EZEANI
Authorized Official - Last Name:NWOKENKWO
Authorized Official - Suffix:
Authorized Official - Credentials:FOREIGN MD
Authorized Official - Phone:815-588-5506
Mailing Address - Street 1:4001 W DEVON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4538
Mailing Address - Country:US
Mailing Address - Phone:773-777-6611
Mailing Address - Fax:773-777-6633
Practice Address - Street 1:4001 W DEVON AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4538
Practice Address - Country:US
Practice Address - Phone:773-777-6611
Practice Address - Fax:773-777-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000522332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5081720001Medicare NSC