Provider Demographics
NPI:1346320041
Name:MB CARE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MB CARE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MB CARE MEDICAL SUPPLY
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-615-0860
Mailing Address - Street 1:318 W MADISON AVENUE
Mailing Address - Street 2:SUITE M
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-615-0860
Mailing Address - Fax:708-615-0876
Practice Address - Street 1:318 W MADISON AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-615-0860
Practice Address - Fax:708-615-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000226332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
01620637OtherBLUE CROSS BS OF ILLINOIS
IL=========Medicaid
01620637OtherBLUE CROSS BS OF ILLINOIS