Provider Demographics
NPI:1629015904
Name:AD MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:AD MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKWOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-292-1940
Mailing Address - Street 1:6160 N CICERO AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4327
Mailing Address - Country:US
Mailing Address - Phone:773-292-1940
Mailing Address - Fax:773-292-1939
Practice Address - Street 1:6160 N CICERO AVE STE 503
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4327
Practice Address - Country:US
Practice Address - Phone:773-292-1940
Practice Address - Fax:773-292-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid
IL=========-001Medicaid
4761150001Medicare NSC