Provider Demographics
NPI:1679568604
Name:BARDACH-SCHOENE COMPANY INC.
Entity Type:Organization
Organization Name:BARDACH-SCHOENE COMPANY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED & LICENSED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEJORADA
Authorized Official - Suffix:
Authorized Official - Credentials:CPLP
Authorized Official - Phone:708-456-8780
Mailing Address - Street 1:7318 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4234
Mailing Address - Country:US
Mailing Address - Phone:708-456-8780
Mailing Address - Fax:708-456-6411
Practice Address - Street 1:7318 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4234
Practice Address - Country:US
Practice Address - Phone:708-456-8780
Practice Address - Fax:708-456-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
IL211000146335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211000146OtherPROSTHETIC LICENSE/STATE OF ILLINOIS
IL=========001Medicaid
IL=========001Medicaid