Provider Demographics
NPI:1376657791
Name:AVMED SURGICAL SUPPLY, INC
Entity Type:Organization
Organization Name:AVMED SURGICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-635-8900
Mailing Address - Street 1:8802 W DEMPSTER
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3097
Mailing Address - Country:US
Mailing Address - Phone:847-635-8900
Mailing Address - Fax:847-635-8901
Practice Address - Street 1:8802 W DEMPSTER
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3097
Practice Address - Country:US
Practice Address - Phone:847-635-8900
Practice Address - Fax:847-635-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1195956332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0485370001Medicare NSC
0485370001Medicare PIN