Provider Demographics
NPI:1407920473
Name:WINDHAM MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:WINDHAM MEDICAL SUPPLIES
Other - Org Name:MATT WINDHAM JR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-288-2844
Mailing Address - Street 1:2056 EAST 71ST STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2117
Mailing Address - Country:US
Mailing Address - Phone:773-288-2844
Mailing Address - Fax:773-288-2848
Practice Address - Street 1:2056 EAST 71ST STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2117
Practice Address - Country:US
Practice Address - Phone:773-288-2844
Practice Address - Fax:773-288-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RFP797FSS990025R4OtherVA NATIONAL ACQUICITION C
0913970001Medicare NSC