Provider Demographics
NPI:1508812876
Name:HARVEST MEDICAL SUPPLY, LTD
Entity Type:Organization
Organization Name:HARVEST MEDICAL SUPPLY, LTD
Other - Org Name:HARVEST MEDICAL SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-853-0901
Mailing Address - Street 1:1550 E. HIGGINS RD.
Mailing Address - Street 2:STE #105
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1687
Mailing Address - Country:US
Mailing Address - Phone:773-853-0901
Mailing Address - Fax:773-930-3920
Practice Address - Street 1:1550 E. HIGGINS RD.
Practice Address - Street 2:STE #105
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1687
Practice Address - Country:US
Practice Address - Phone:773-853-0901
Practice Address - Fax:773-930-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1245812332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633265OtherBCBS OF ILLINOIS
IL=========001Medicaid
4502920001Medicare NSC