Provider Demographics
NPI:1619641461
Name:BOOMERS MEDICAL GEAR PLLC
Entity Type:Organization
Organization Name:BOOMERS MEDICAL GEAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC SENIOR MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-440-2164
Mailing Address - Street 1:4701 N CUMBERLAND AVE SUITE 12
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-2905
Mailing Address - Country:US
Mailing Address - Phone:708-452-8800
Mailing Address - Fax:708-452-7990
Practice Address - Street 1:4701 N CUMBERLAND AVE SUITE 12
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2905
Practice Address - Country:US
Practice Address - Phone:708-452-8800
Practice Address - Fax:708-452-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies