Provider Demographics
NPI:1558646588
Name:HIGH TECH MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:HIGH TECH MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:SHOAIB
Authorized Official - Last Name:YOUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-606-4001
Mailing Address - Street 1:753 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6171
Mailing Address - Country:US
Mailing Address - Phone:630-606-4001
Mailing Address - Fax:
Practice Address - Street 1:350 W 22ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6449
Practice Address - Country:US
Practice Address - Phone:630-606-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNONE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherNONE YET