Provider Demographics
NPI:1558827535
Name:FAM MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:FAM MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-603-4226
Mailing Address - Street 1:1321 W 111TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3648
Mailing Address - Country:US
Mailing Address - Phone:877-603-4226
Mailing Address - Fax:866-365-4843
Practice Address - Street 1:1321 W 111TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3648
Practice Address - Country:US
Practice Address - Phone:877-603-4226
Practice Address - Fax:866-365-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies