Provider Demographics
NPI:1346551231
Name:AFFINITY MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:AFFINITY MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMUALDO
Authorized Official - Middle Name:BRUM
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-285-1758
Mailing Address - Street 1:2182 GLADSTONE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1517
Mailing Address - Country:US
Mailing Address - Phone:847-285-1758
Mailing Address - Fax:847-285-1759
Practice Address - Street 1:2182 GLADSTONE CT
Practice Address - Street 2:SUITE C
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1517
Practice Address - Country:US
Practice Address - Phone:847-285-1758
Practice Address - Fax:847-285-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39923691332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies