Provider Demographics
NPI:1639440035
Name:AFFORDABLE DME
Entity Type:Organization
Organization Name:AFFORDABLE DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-999-7494
Mailing Address - Street 1:115 WEST MAIN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-2110
Mailing Address - Country:US
Mailing Address - Phone:815-999-7494
Mailing Address - Fax:
Practice Address - Street 1:115 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BRAIDWOOD
Practice Address - State:IL
Practice Address - Zip Code:60408-2110
Practice Address - Country:US
Practice Address - Phone:815-999-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid