Provider Demographics
NPI:1376985929
Name:MELROSE MEDICAL SUPPLY COMPANY, LLC
Entity Type:Organization
Organization Name:MELROSE MEDICAL SUPPLY COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWETLAND-PILATI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-860-3273
Mailing Address - Street 1:1701 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3433
Mailing Address - Country:US
Mailing Address - Phone:312-860-3273
Mailing Address - Fax:
Practice Address - Street 1:1811 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2025
Practice Address - Country:US
Practice Address - Phone:312-860-3273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies